Application Of Lung Protective Ventilation Strategy In Radiofrequency Ablation Of Atrial Fibrillation

Background and Objective:Atrial fibrillation is one of the most common clinical arrhythmias,and radiofrequency catheter ablation as a first-line treatment of atrial fibrillation has been widely used in clinical.Radiofrequency ablation is done in sedation or general anesthesia,both of which have advantages and disadvantages.In the literature,patients with conscious sedation can not tolerate the pain and discomfort caused by surgery,poor braking,often interfere with the operation process;and deep sedation of patients from sedation caused by respiratory depression,circulatory suppression and other adverse events high,sudden physical increase in the risk of pericardial tamponade;by contrast,general anesthesia patients in an unconscious state,good sedative analgesic so that patients can not make any stimulation of the reaction,no physical movement,and mechanical ventilation can be a regular breathing,reducing the respiratory movement of radiofrequency ablation,but postoperative pulmonary complications(PPCs)has a higher incidence.The occurrence of PPCs affects the recovery of patients,prolongs hospitalization,increases health care costs,and even causes death.Therefore,it is of great practical significance to reduce the occurrence of PPCs after radiofrequency ablation of atrial fibrillation.In recent years,lung protective ventilation strategy has been widely used in ICU patients with mechanical ventilation,play a good role in lung protection.Recently,some scholars have applied the lung protective ventilation strategy to ventilatory management in some surgical procedures and believe that the ventilation strategy can benefit some patients.Radiofrequency ablation of atrial fibrillation in the use of high tidal volume often affect the operation,the impact of ablation results,and simple low tidal volume ventilation may lead to atelectasis,lung protective ventilation strategy can make up for these deficiencies.This study was designed to investigate the clinical significance of lung protective ventilation strategies for patients undergoing radiofrequency ablation of atrial fibrillation in general anesthesia.Materials and methods:From September 2016 to February 2017,60 patients were randomly selected from the Department of Cardiac Surgery at the First Affiliated Hospital of Dalian Medical University to receive radiofrequency ablation of atrial fibrillation.There were 34 males and 26 females,aged 48 to 80 years,ASA grade ?-?.Were randomly divided into group L(lung protective ventilation group)and group C(conventional ventilation strategy group).All patients underwent catheter ablation by the same surgeon under the guidance of the CARTO-3 three-dimensional mapping system.After the intubation of the general anesthesia,the ventilation parameters were set,and the group L was set with tidal volume of 6?8ml/kg,PEEP 5cmH20,intermittent pulmonary resuscitation;group C was set at 8?10ml/kg tidal volume,and the respiratory rate was adjusted according to PETCO2,so that PETCO2 maintained at 35?45mmHg.At the end of intubation,1h after ventilation,2h after ventilation,24 hours after the operation of arterial blood gas,intraoperative recording of carbon dioxide at the end of breath,airway pressure.Record the time of operation,ablation time,fluoroscopy time and immediate success rate of ablation,and record the satisfaction of the surgeon.Postoperative follow-up of patients with pulmonary complications,and record the patient's hospital stay.Results:(1)There were no significant differences in gender,age,height,body weight,BMI,ASA grade,type of atrial fibrillation,and complication in the two groups,P>0.05;(2)Pa02 of T4 time higher than Ti time in group L(89.17 ± 17.05 VS 87.03 ±11.38);PaO2 of T4 time lower than Ti time in group C(87.07 ± 8,12 VS89.77±11.67);at T2,T3 time,PaCO2 in group L slightly higher than the group C(36.80 ± 2.92 vs 35.10 ±2.72 and 37.33 ± 2.19 vs 35.83 ± 2.3 1),the airway pressure in group C was higher than that in group L(16.4 ± 3.4 vs 18.4 ± 3.0 and 16.3 ± 3.5 vs 18.5±2.9),But P>0.05,no significant difference;(3)The time of operation(126.03±41.25 VS 136.83±41.73),the time of fluoroscopy(11.1817.92 VS 12.7317.29),the time of ablation(40.2317.79 VS 43.37±11.63)and the number of hospitalizations(8.21±4.1 VS 9.0±4.7)in group L were shorter than those in group C,but P>0.05,which was not statistically significant;the success rate of surgery was 100%in both groups;there was no significant difference in the postoperative complications between the two groups(P>0.05);(4)There was no significant difference between the two groups in the occurrence of PPCs and the PPCs grade,P>0.05;(5)The satisfaction degree of ventilation was divided into three grades,there was significant difference between the two groups(P<0.01).Conclusion:Compared with the conventional tidal volume ventilation strategy,although the lung protective ventilation strategy for atrial fibrillation catheter radiofrequency ablation did not reduce the incidence of postoperative pulmonary complications,but the latter provides a low tidal volume to better meet the surgeon intraoperative operation,therefore,the lung protective ventilation strategy is suitable for use in general anesthesia AF radiofrequency ablation of ventilation management.