The Influence Of Different Models Of Mechanical Ventilation On Respiratory Function And Plasma IL-10,IL-8and TNF-α In Elderly Patients Who Underwent Radical Surgery For Abdominal Tumors Under General Anesthesia

Objective:To provide mechanical ventilation with different tidal volume (VT) and positive end expiratory pressure (PEEP) in elderly patients who underwent radical surgery for abdominal tumors under general anesthesia, whose experimental data,such as respiratory function,inflammatory cytokines and arterial blood gas analysis,were compared at each time point. Through this study we can seek a suitable mode of mechanical ventilation for elderly patients, in order to provide a theoretical and experimental basis for mechanical ventilation safety implementation in clinical anesthesia.Methods:1Sixty elderly patients in ASA Ⅰ or Ⅱ who underwent radical surgery for abdominal tumors under general anesthesia were randomly divided into three groups with20cases in each. Low Vt and low level PEEP mechanical ventilation were applied to the patients in group A (VT=6ml/kg, PEEP=5cmH2O); traditional ventilation was used in group B (VT=10ml/kg, PEEP=0);while group C (VT=6ml/kg, PEEP=8cmH2O) were administered with low VT and high level PEEP.2Arterial blood samples were taken and PaCO2PaO2,A-aDO2,PaO2/FiO2, Ri, Ppeak and Pplat were recorded before anesthesia induction,mechanical ventilation60min and15min after tracheal extubation.3Plasma levels of IL-10, IL-8and TNF-α were measured by enzyme linked immunosorbent assay (ELISA) technique before anesthesia induction,10min after the start of surgery, mechanical ventilation60and120min and15min after tracheal extubation.Results:1Compare with group A, PaO2and PaO2/FiO2was lower, while A-aDO2and Ri was higher in group B at15min after tracheal extubation. And group C has lower in PaO2/FiO2,higher in Ri than group A at the same time. There was no significant difference in PaCO2、PaO2、 A-aDO2、PaO2/FiO2、Ri、Ppeak、Pplatat each time point among the three groups.2At1Omin after the start of surgery, Serum levels of IL-10, IL-8and TNF-α in each groups increased significantly. Both group B and group C showed significantly higher serum levels of IL-10, IL-8and TNF-α in various degree at different time.At mechanical ventilation60 and120min, group B was higher in serum levels of TNF-α, while group C was higher in serum levels of IL-10.Both group B and group C showed significantly higher serum levels of IL-10, IL-8and TNF-α at15min after tracheal extubation.Conclusions:This study shows that mechanical ventilation with low VT combined with low level of PEEP were less influence on the release of inflammatory cytokines, which can effectively reduce ventilator-associated lung injury (ventilator induced lung injury, VILI), It is beneficial to recovery of respiratory function, and decrease complications of lung,then become a safe and effective method of ventilation for elderly patients who underwent radical surgery for abdominal tumors under general anesthesia.