| Background: The high occurrence of postoperative pulmonary compli-cations (PPCs) cost enormous medical resources and burdened oursociety and patients’ family heavily, thus received medical atten-tion. Soon after the beneficial effects of protective pulmonaryventilation in acute respiratory distress syndrome, patients weredemonstrated, protective pulmonary ventilation has been constantlyconducted in normal patients undergoing general anesthesia inoperation room to see if the former effect exist. Recent meta-analysis shows that protective pulmonary ventilation, mainly lowertidal volume, decreased the incidence of PPCs and improved clinicaloutcomes. Later RCT experiments came to similar conclusions.However, seldom researches about protective pulmonary ventilationin elderly patients undergoing arthroplasty were reported. Agedpatients get a higher incidence of PPCs after arthroplasty. It isimportant to verify the effects of protective pulmonary ventilationon PPCs in elderly patients undergoing arthroplasty.Objective: To investigate the effect of protective pulmonaryventilation on PPCs in elderly patients undergoing arthroplasty. Method: In this randomized controlled trial, we collected86elderlypatients undergoing selective total hip arthroplasty or total kneearthroplasty in the Bone and Joint Surgery department of the firstBethune hospital of Jilin University from May.2014to Feb.2015.All of the patients were no less than65years old.86patients wererandomly assigned to protective pulmonary ventilation group(n=43) and conventional ventilation group(n=43). The same equipmentwere used to routine monitoring including electrocardiogram(ECG),invasive arterial blood pressure and Narcotrend. The same medicinewere used to anaesthesia process. Patients in conventionalventilation group received tidal volume of8～10ml/kg PBW, no PEEPor recruitment maneuver; while protective pulmonary ventilationgroup6ml/kg PBW with6～8cm H2O PEEP and recruitment maneuver every30min. The respiratory frequency were regulated to maintain PETCO2within35～45mmHg. Record the following preoperative and intra-operative index: heart rate, invasive arterial blood pressure,surplus pulse O2(SpO2), arterial blood gas analysis of pH, PaO2, PaCO2,the volume of bleeding, blood transfusion, infusion volume and urinevolume. The primary outcome was a clinical definition of postope-rative pulmonary complications, and the secondary outcome was theincidence of ICU stay and duration of hospital stay after surgeryin28days. Major indicators during surgery and patient status were gathered to final conclusion.Results: The baseline characteristics of both compared groups weresimilar in age, height, weight, ASA grade, gender, number of totalhip arthroplasty/total knee arthroplasty and SpO2. There were nodifferences in heart rate, invasive arterial mean pressure(MAP),Hb, PaO2, PaCO2, pH and PaO2/FiO2in both groups. Compared with theconventional pulmonary ventilation group, protective pulmonaryventilation group got lower peak airway pressure(16.4±2.0cm H2Ovs.22.7±4.8cm H2O，p <0.01).and higher mean airway pressure（13.0±2.1cm H2O vs.10.7±1.7cm H2O，p<0.01）. The morbidity ofPPCs in protective pulmonary ventilation group was significantlyhigher than conventional pulmonary ventilation group (3/43(6.98%)vs.11/43（25.58%), p=0.041). Incidence of ICU stay was1/43(2.13%)in protective group, and2/43(4.26%) in conventional group, nosignificance with p=0.557. The hospital-stay after surgery inprotective pulmonary ventilation group was shorter than conven-tional group(8.4±2.3days vs.10.5±4.9days，p=0.013). At1h afterextubation(T3), protective pulmonary ventilation group showedlower PaCO2(44.3±3.9mmHg vs.42.0±3.6mmHg，p=0.007). Patientsreceiving total hip arthroplasty experienced more intraoperativeblood loss（1168.3±204.9ml vs.354.4±169.5ml，p=0.00）, moreblood transfusion（3.3±0.7U vs.0.9±0.7U，p=0.00） and longer mechanical ventilation time（157.6±19.3min vs.111.3±16.0min，p=0.00）than the ones receiving total knee arthroplasty whileincidence of PPCs were similar in both surgery types with p=0.693.The hospital-stay after surgery of patients with PPCs was longerthan the ones without（16.4±5.7days vs.8.8±1.0days, p <0.01）.Conclusion: The practice of protective pulmonary ventilationreduced PPCs in elderly patients undergoing artificial arthroplastyand shortened the hospital-stay after surgery. The incidence of PPCswere similar between total hip arthroplasty and total kneearthroplasty. The hospital-stay after surgery of patients with PPCswas longer than the ones without. |
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