| BackgroundHepatocellular neoplasm is a common malignancy in China.Laparoscopic partial hepatectomy is an increasingly common surgical procedure,which is widely used to treat various liver diseases.However,postoperative pulmonary complications are one of the most common complications after liver surgery,including postoperative pneumonia,dry cough,chest tightness and so on.Postoperative pulmonary complications may lead to postoperative pulmonary dysfunction,prolonged hospital stay and even reduced quality of life.Mechanical ventilation with the lung protective ventilation strategy can improve oxygenation and reduce the incidence of postoperative pulmonary complications such as atelectasis and pulmonary infection.ObjectiveThis prospective study investigated whether the use of protective lung ventilation reduces the incidence of postoperative pulmonary complications in patients undergoing laparoscopic partial hepatectomy.MethodsIn this study,a randomized controlled trial was conducted on 310 patients who underwent elective laparoscopic partial hepatectomy in the Department of Anesthesia Surgery on January 1,2019,solstice and December 1,2020,after the approval of the Ethics Committee of the Provincial Hospital Affiliated to Shandong First Medical University.By random number table method,they were divided into two groups:conventional ventilation group(T group)and lung protective ventilation strategy group(P group).310 patients who underwent laparoscopic hepatectomy of perioperative patients with the same basic monitoring including blood oxygen saturation,temperature,at the end of the electrocardiogram,exhale carbon dioxide and advanced hemodynamic detection,including the continuous monitoring of blood pressure and arterial pressure,central venous pressure monitoring,after a certain time of blood gas analysis,as well as the usage of narcotic drugs,Monitor indicators:peak airway pressure and lung compliance were closely observed during mechanical ventilation.Paired t-test was used to compare the blood gas analysis indexes(PaO2,PaC02),blood pressure,heart rate,mean arterial pressure and blood oxygen saturation at each time point.The peak airway pressure and pulmonary compliance at 0.5h,1.5h,2.5h and 3.5h after intubation were compared.Chi-square test and Fisher’s exact test were used to compare the oxygenation indexes and the incidence of postoperative complications(chest tightness,cough,dyspnea,etc.)between the conventional ventilation group and the pulmonary protective ventilation strategy group.ResultsThrough pairwise comparison of oxygenation indexes(PaO2,PaCO2),peak airway pressure and lung compliance at specific time between the conventional ventilation group and the lung protective ventilation group,it was found that the differences between the two groups were statistically significant(P<0.05).There was no significant difference in MAP,HR and SpO2%(P>0.05).In the lung protective ventilation group,the blood gas indexes PaO2,PaCO2,peak airway pressure,lung compliance and the incidence of postoperative pulmonary complications were significantly different(P<0.05).By grouping PaO2 and PaCO2,it was found that at T1,T5 and T6,PaO2 in the control group was lower than that in the observation group(P<0.05),and PaO2 in the control group was higher than that in the observation group(P<0.05).Pairwise comparison of peak airway pressure and lung compliance at T2 and T3 showed that the peak airway pressure in the control group was higher than that in the observation group(P<0.05),while the lung compliance in the control group was lower than that in the observation group(P<0.05).There was no statistical significance in pairwise comparison of MAP,HR and SpO2%(P>0.05).ConclusionsThis study shows that the application of protective lung ventilation strategy in the process of long-term mechanical ventilation such as laparoscopic partial hepatectomy can effectively improve oxygenation indexes of lung function and improve postoperative pulmonary complications to a certain extent. |
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