Effects Of Ulinastatin Combined Pressure Controlled Ventilation On Pneumodynamics Of Laparoscopic Surgery

Objective: CO2 pneumoperitoneum is conventional methods of artificial pneumoperitoneum on gynecological laparoscopic surgery.The influence on respiration is great that makes abdominal pressure higher, diaphragm parallel driving up, chest volume shrinking and leads to increased peak inspiratory pressure and reduces functional residual capacity, pulmonary compliance,lung capacity. Ulinastatin can inhibit inflammatory factor,maintain the balance of proinflammatory and anti-inflammatory systems and improve lung function.It can reduce the effects of CO2 pneumoperitoneum on respiration dynamics that combine with the best ventilation mode.It provides new theoretical support for gynecologic laparoscopic surgery to minimize the impact on respiratory dynamics.Methods: Eighty patients(ASA classification I or II), aged 20~60 y, with a body index of 1 8~24 kg/m2, scheduled for laparoscopic surgery under general anesthesia, were randomly divided into 2 groups( n=20): pressure controlled ventilationon group(group P),volume controlled ventilationon group(group C); ulinastatin combined pressure controlled ventilationon group(group PU); ulinastatin combined volume controlled ventilationon group(group CU). PU and CU group was gived ulinastatin 10000U/kg before operation.Excluding chronic obstructive airway disorders, drug allergy, liver and kidney function. All patients with preoperative fasting the drink of 8 h, unused preoperative medication.Opening peripheral venous pathway and regularly monitoring ECG, BP, HR, SPO2 and PETCO2,when patient is in the operating room.Induction of intravenous sodium lactate ringer’s solution 10 ml/(kg·h) and intraoperative intravenous sodium lactate ringer’s solution 6 ml/(kg·h) before anesthesia, and according to the amount of blood loss and urine intravenous infusion of 6% hydroxyethyl starch. Anesthesia was induced with midazolam, fentanil, propofol and vecuronium. The patients were tracheal intubated and mechanically ventilated. The respiratory mechanic paremeters of compliance(CL), resistance(Raw), peak airway pressure(Pmax), plateau pressure(Pplat), mean pressure(Pmean), positive end expiratory pressure(PEEP) were recorded at the time of supine position(T0), the pneumoperitoneum instantly(T1), 5 min of pneumoperitoneum after changing position(T2), pneumoperitoneum after 20 min(T3), deflating after 5 min(T4) and the end of the surgery after 5min(T5).Results: The Raw, Pmax, Pplat, Pmean were significantly higher after CO2 pneumoperitoneum in the four groups(P<0.01). After CO2 pneumoperitoneum, the Raw of PU and CU group was lower than other groups(P<0.05). The Cl was significantly lower after CO2 pneumoperitoneum in the four groups( P<0.01). At T4, Cl was lower in group PU( P<0.05), but at T5 Cl was recovery( P<0.05). Compared with other groups, the Cl was significantly higher in group PU( P<0.01).Conclusion: 1.The ulinastatin combined pressure controlled ventilation mode can be used in gynecological laparoscopic surgery, has certain effect on improving lung compliance and making lung compliance recover fast; 2. The ulinastatin combined pressure controlled ventilation model is better than the other three groups in gynecological laparoscopic surgery.