Effects Of Adjuvant Small Tidal Volume IPPV For Nondependent Lung On The Inflammatory Response In Patients With Peripheral Lung Cancer Undergoing Thoracotomy

Objective:To investigate the effect of small tidal volume IPPV fornondependent lung on the inflammatory response and prognosis in patientswith peripheral lung cancer undergoing thoracotomy.Methods:Twenty ASAⅠor Ⅱpatients of both sexes, aged45~65yr,weighing49~80kg, not combined with serious cardiovascular diseases, lungdysfunction, liver dysfunction or rental dysfunction were randomly dividedinto two groups. The patients did not have diseases of immune system,endocrine system, nervous system or mental system, and they did notreceive chemotherapy, radiotherapy or hormonotherapy which will restrainthe immunity. The patients were attracted by lung cancer who were in chargeof surgeries in the same groups and their operations were in the left thorax.They were allocated randomly into two groups: Intermittent posititve-pressureveitilation (IPPV)group(group A) and control group(groupB). The upper limbvenous access was founded after entering the operation room. The patientswere insused with Lactated Ringer solution and hydroxyethyl starch(130/0.4)sodium chloride at the infusion rate of15ml/kg/h. Atropine0.5mgand midazolam0.05mg/kg30min were given before operation. Perioperativemonitoring included Electriccadiogram (ECG), Saturation of Pulse Oximetry(SpO2), invasive arterial blood pressure (ABP), Central Venous Pressure(CVP),Ppeak,Pplat and PETCO2with IntelliVue MP50multifunctionalmonitor. Anesthesia was induced with Fentanyl2~4μg/kg, Etomidate0.2~0.3mg/kg, Cisatracurium0.3mg/kg after their consciousness disappearing.Double lumen endobronchial tube was inserted by the same skillful anesthetist.Correct positioning was verified by fiberoptic bronchoscopy. After trachealintubation, the patients were mechanically ventilated with Datex-Ohmeda 7100anaesthesia machine, and the oxygenflow was1L/min. During two lungventilation, the ventilation modes were performed (VT8~10ml/kg, I:E with1:2,Respiratory Frequency12times/min). The OLV ventilation modes wereperformed (VT6~8ml/kg, I:E with1:2, Respiratory Frequency15~17times/min). PETCO2was maintained at35~45mmHg, the peak voltage ofairtube was undered35cmH2O. The bronchial tube of operation side lung incontrol group opened in the air directly.The bronchial tube of operation sidelung in experimental group was connected with Datex-Ohmeda7100Ventilator and the respiration parameters were performed (VT1.2ml·kg-1,respiratory Frequency15times/min, I:E with1∶2,the oxygenflow was1L/min). We used Sevoflurane(1~3%) and Remifentanil（0.5~1μg/kg/min）combined intravenous-inhalational anesthesia(CIIA) in maintenance ofanesthsia. The Bispectral Index was monitored and its value was maintainbetween40~60. Cisatracurium was given every30minutes to provide asatisfactory degree of muscle relaxation at0.05mg/kg. We used regular fluidinfusion and adjusted the depth of anesthesia in time to keep hemodynamicstable, the amplitude of variation of mean arterial pressure and heart rate wasbelow20%of the basic value. The pH, arterial partial pressure ofoxygen(PaO2), artery partial pressure of CO2(PaCO2), Lac and BE weremeasured by Cabs b123blood-gas analyzer at3timing: before intubation,after the cancer specimen was removed, the end of OLV. In addition, theHeart Rate (HR), Saturation of Pulse Oximetry(SpO2), Mean BloodPressure(MBP), Central Venous Pressure(CVP) were recorded at everytime-point above.Recorded the duration of OLV, the duration of surgery, fluidvolume, urine volume, blood loss and blood infusion volume in the twogroups. Blood samples were taken from internal jugular, blood gas analysisand plasma IL-8, IL-10, TNF-α were determinated at after intubation(T0),after operation (T1),24h after operation (T2),48h after operation.Post-operation follow-up: the duration of chest drainage, drainagevolume, extubation time, therapeutic time of antibiotics, length of stay(LOS),expenses, whether transferred to ICU, vital signs, body temperature changes. Result:(1)There were no significant differences in the age, BMI, gender, theduration of OLV, the duration of surgery, fluid volume, urine volume andblood loss in the two groups（P>0.05）.(2)Detection index①No significant differences in the two groups were found in IL-8, IL-10,TNF-α at T0, T1, T2, T3（P>0.05）.②No significant differences in the two groups were found in IL-8, IL-10,TNF-α at T1, T2, T3（P>0.05）③IL-8, IL-10, TNF-α were significantly different among T0, T1, T2,T3(P <0.05) in groupA. IL-8were significantly increased in T1comparedwith T0, and were decreased from T2. IL-8, IL-10, TNF-α was significantlydecreased compared with T0. IL-10were significantly increased in T1compared with T0, and were decreased from T2. IL-8, IL-10, TNF-α wassignificantly decreased compared with T0. TNF-α had no obvious changetrend.④IL-8, IL-10, TNF-α were significantly different among T0, T1, T2,T3(P <0.05) in groupB. IL-8were significantly increased in T1compared withT0, and were decreased from T2. IL-8, IL-10, TNF-α was significantlydecreased compared with T0. IL-10were significantly increased in T1compared with T0, and were decreased from T2. IL-8, IL-10, TNF-α wassignificantly decreased compared with T0. TNF-α had no obvious changetrend.⑤There were no significant differences in the duration of chest drainage,length of stay(LOS), expenses, body temperature changes, heart rate, spo2,blood pressure in the two group（sP>0.05）. There were significant differencesin drainage volume, therapeutic time of antibiotics in the two groups.⑥There were no significant differences in pH, arterial partial pressure ofoxygen(PaO2), artery partial pressure of CO2(PaCO2), Lac and BE at the three time points in the two groups.Conclusion: Adjuvant small tidal volume IPPV for nondependent lungcan not remmit the inflammatory response in patients with lung cancerundergoing thoracotomy, but it can improve the prognosis and improve thearterial partial pressure of oxygen.