Effects Of Different Intermittence Time Lung Recruitment Maneuver For The One Lung Ventilation On The Inflammatory Factor, Oxygenation Index And Inflammatory Factor

Objective: To compare the effects of with different intermittence timelung recruitment maneuver for the one lung ventilation on the inflammatoryfactor, oxygenation index and intrapulmonary shunt.Methods: Rorty ASA Ⅰo r Ⅱp atients of both sexes, aged65-75yr,weighing65-80kg, were randomly divided into four groups (n=10each):intermittent one lung ventilation each30min with lung recruitment maneuver(group A), intermittent one lung ventilation each60min with lung recruitmentmaneuver (group B), intermittent one lung ventilation each120min with lungrecruitment maneuver (group C),before the end of one lung ventilation withlung recruitment maneuver (group D). Perioperative monitoring includedelectrocardiogram, heart rate, peripheral oxygen saturation, invasive meanarterial blood pressure, heart rate variability, bispectral index，PETCO2,Ppeakand Pplat. Anesthesia was induced with sufentanil0.2-0.4μg·kg-1, propofol1.5-2.0mg·kg-1, cisatracurium0.15mg·kg-1. After tracheal intubation, thepatients were mechanically ventilated. The ventilation modes wereperformed(VT10ml·kg-1, I:E with1:1.5, oxygen flow rate1.5L·min-1). BISwas maintained at40-50during the operation. The one lung ventilation (OLV)modes were performed(VT6ml·kg-1, I:E with1:1.5, PEEP:5cmH2O,oxygenflow rate1.5L·min-1). PETCO2was maintained at35-45mmHg, the peakvoltage of air tube was undered30cmH2O. During OLV, there wasintermittent each30min with lung recruitment maneuver (group A),intermittent each60min with lung recruitment maneuver (group B),intermittent each120min with lung recruitment maneuver (group C), beforethe end of one lung ventilation with lung recruitment maneuver (group D)Artery blood gas analysis at enter the room (T0), before (T1),30min(T2), 1h(T3),2h(T4),3h(T5), end of OLV(T6), end of operation(T7),30min afterdouble lung ventilation(T8). Plasma IL-6, TNF-a, IL-10concentration weredeterminated at after enter the room (T0),2h of OLV(T4), end ofoperation(T7),2h after operation (T9) and24h after operation (T10)again.Blood samples were taken from internal jugular. Oxygenation index(OI) andintrapulmonary shunt(Qs/Qt) were calculated.Results: There were no significant differences in the age, gender, weigh,the types of surgery, the duration of OLV, the duration of surgery, fluid volume,urine volume and blood loss in all the groups（P>0.05）.No significant differences were found in IL-6, TNF-α, IL-10, OI andQs/Qt at T0in all the groups（P>0.05）. IL-6, TNF-α, IL-10were significantlyincreased at T4, T7, T9and T10compared with the baselines at T0in all thegroup（P>0.05）. Compared with group A, IL-6, TNF-α, IL-10in group B andC were lower at T4, T7, T9and T10（P<0.05）; in group D were lower at T4（P<0.05）. Compared with the group B and C, IL-6, TNF-α, IL-10in thegroup D were higher at T7, T9and T10（P<0.05）. OI were significantlydecreased at T2～T6compared with the baselines at T0in all the groups（P<0.05）. Qs/Qt were significantly increased at T2～T6compared with thebaselines at T0in all the groups（P<0.05）. Compared with the group A and B,OI were higher in the group C and D at T6（P<0.05）; Qs/Qt were lower in thegroup C and D at T6（P<0.05）.No significant differences were found at T1～T5and at T7～T8in all the groups（P>0.05）.Conclusion:1Undergoing persistent long time one lung ventilation, the patients`intrapulmonary shunt and oxygenation index will gradually improve after thethoracic surgical procedures, however, the rapidly rise of inflammatory factorwill lead to ALI when the lung recruitment maneuver ultimately.2The patients who undergoing unsustainability long time one lungventilation should lung recruitment maneuver after one lung ventilation120min, and according to intrapulmonary shunt, oxygenation index andinflammatory factor, this will relieve ALI cause by lung recruitment maneuver.