Effect Of Ventilation Mode On Hemodynamics And Postoperative Pulmonary Complications In Elderly Patients Undergoing Laparoscopic Surgery

Objective:To evaluate the clinical application advantages of two ventilation modes in elderly patients undergoing laparoscopic surgery by observing perioperative hemodynamic changes and pulmonary complication,so as to provide theoretical reference for ventilation strategies in elderly patients undergoing laparoscopic surgery.Methods:Sixty elderly patients undergoing elective colorectal cancer surgery in our hospital were included in this study.The patients were randomly divided into volume-controlled ventilation group（VCV,group V）and pressure-controlled ventilation group（PCV,group P）at a ratio of 1:1.After induction of general anesthesia,all patients were intubated.In volume-controlled ventilation group,the mechanical ventilation parameters were set as tidal volume 6-8ml/kg,an inhalation-to-breath ratio of 1:2,respiratory rate was adjusted to maintain P_ETCO₂at 35-45 mm Hg,and the maximum inspiratory pressure was 40 mm Hg.In pressure-controlled ventilation group,volume control ventilation was performed according to the target tidal volume after intubation and the plateau pressure was measured.The set point for inspiratory pressure was the measured plateau pressure,and the pressure and respiratory rate were adjusted to maintain P_ETCO₂ at 35-45mm Hg.The blood pressure,mean arterial pressure,heart rate,oxygen saturation and lung ultrasound score（LUS）were recorded and compared between patients entering the operating room（T₀）and 10 minutes after tracheal catheter removal（T₉）.The patients were recorded and compared 5 minutes after tracheal intubation（T₁）,10 minutes after tracheal intubation（T₂）,15 minutes after tracheal intubation（T₃）,10 minutes after the establishment of artificial pneumoperitoneum（T₄）,15 minutes after the establishment of artificial pneumoperitoneum（T₅）,20 minutes after the establishment of artificial pneumoperitoneum（T₆）,60 minutes after the establishment of artificial pneumoperitoneum（T₇）and 10 minutes after the release of artificial pneumoperitoneum（T₈）respiratory rate,tidal volume,airway pressure,partial pressure of end-respiratory CO₂(P_ETCO₂),oxygen saturation（Sp O₂）,blood pressure,mean arterial pressure,cardiac output and heart rate.Results:1.There were no significant differences in age,gender,height,weight,BMI,ASA,operation time and infusion volume between the two groups（P>0.05）;2.There was no significant difference in hemodynamic indexes between the two groups at each time point（P>0.05）;3.Compared with group V,the peak airway pressure in group P was significantly decreased at T₁-T₈（P<0.05）.4.Compared with group V,there was no statistically significant difference in lung ultrasound score when entering the operating room（T₀）（P>0.05）,but the lung ultrasound score of group P was significantly decreased at 10minutes after tracheal catheter removal（T₉）（P<0.05）.5.The incidence of pulmonary complications in group P was significantly lower than that in group V within 2 days after operation[5 cases（16.7%）vs 13 cases（43.3%）,P<0.05].Conclusion:1.PCV mode significantly improved the pulmonary ventilation in elderly patients undergoing laparoscopic colorectal cancer surgery.2.PCV mode reduces the incidence of postoperative lung complications in elderly patients undergoing laparoscopic colorectal cancer surgery.