Clinical Research Of Applying Lung Protective Ventilation Strategies On Patients Undergo Laparoscopic Surgery

Objective By study the effects of ventilation parameters′adjusting afterrecruitment manoeuvres on respiratory system during the procedure of pelviclaparoscopic surgery, to explore the best ventilation parameters combinationwhen using lung protective ventilation strategies on patients who undergoinggeneral anesthesia laparoscopic surgery.Methods36patients undergoing regular elective laparoscopic cervicalcancer radical surgery were included in this study, ASAⅠ~Ⅱ. All patients weredivided into nine groups according to the four factors three levels repeatedorthogonal experimental design, each group including four patients. All patientswere under total intravenous anesthesia and ventilated mechanically, intermittentpositive pressure ventilation mode. Recruitment manoeuvres were carried outafter establishing stable carbon dioxide pneumoperitoneum and adjusting theposition of the patient. Then restored the mechanical control ventilation and adjusted ventilation parameters according to the set of different group. MAP, HR,SPO2, PETCO2, PIP and Pmean were recorded before anesthesia induction,before and60minutes after pneumoperitoneum was established. Extracted radialartery blood for blood gas analysis before and60minutes afterpneumoperitoneum was established.Results⑴Operation were all smoothly accomplished, the vital signs of allpatients were stable under general anesthesia with nine combinations of therespiratory parameters, SPO297%-100%. Accidental ventricular premature beatappeared in3patients. Nine groups of the patients compared to age, weight,height were not statistically significant. There is no statistical difference betweenpatients with HR, MAP and PaO260minutes after pneumoperitoneum wasestablished.⑵Range analysis results:①The significance ofdifferent combinations influencing the PETCO2isf>VT>PEEP>I:E, to get lower PaCO2the best combination is f=18times/min,VT=12ml/kg, I:E=2:1,PEEP=10cmH2O;②The significance of different combinations influencing the PIP is VT>PEEP>I:E>f, to get lower PIP the best combination is f=10times/min,VT=6ml/kg,I:E=2:1,PEEP=4cmH2O;③The significance of different combinations influencing the Pmean isPEEP>I:E>VT>f, to get lower Pmean the best combination is f=10times/min, VT=6ml/kg,I:E=1:2,PEEP=4cmH2O.⑶Differential analysis results:①The effect ofVT、f、PEEP on PaCO2is significant (P<0.01), I:E is not(P>0.05);②The effect ofall factors on PIP is significant (P<0.01);③The effect of all factors on Pmean is significant (P<0.01).Conclutions: In patients who undergoing laparoscopic pelvic laparoscopicsurgery, the best ventilation parameters combination after recruitmentmanoeuvres is A1B3C3D1, as VT=6ml/kg， f=18times/min， I:E=1:2，PEEP=4cmH2O.