Application Of Protective Ventilation Strategy In Pediatric Laparoscopic Surgery During General Anesthesia

Objective:To evaluate the clinical effectiveness of lung protective ventilation strategy in pediatric laparoscopic surgery during general anesthesia,so as to provide reference for clinical application.Methods: Fouty case of pediatric patients with normal lung function in elective pediatric laparoscopic hernia sac high ligation from August 2014 to February 2015 in our hospital were randomly divided into 2 groups:conventional mechanical ventilation group(control group,n = 20)and lung protective ventilation group(observation group,n = 20).In control group,tidal volume(Vt)=10 ml/kg,ideal body weight(IBW),respiration frequency(f)=16 bpm,inspiratory expiratory time ratio(I:E)=1:2,positive end-expiratory pressure(PEEP)=0cmH2O,In observation group,tidal volume(Vt)=7 ml/kg,IBW,respiration frequency(f)=20 bpm,inspiratory expiratory time ratio(I:E)=1:2,positive end-expiratory pressure(PEEP)=6cmH2O,and a manual lung recruitment was performed every fifty minutes.The anesthesia methods and drugs are the same,the concentration of oxygen inhalation was 40%.Compared two groups with the change of hemodynamics,respiratory dynamics,blood gas index and lung cytokines at 5min after intubation(T0),5min after pneumoperitoneum(T1),30 min after pneumoperitoneum(T2)and before extubation(T3),Observe the postoperative pulmonary complications.Results: Two groups of MAP and HR has no statistical significance(P > 0.05)at the point of T0,T1,T2,T3;In observation group,PETCO2,Cdyn are obviously higher than the control group at the point of T0,T1,T2,T3;Ppeak?Pplat are obviously lower than the control groupv at the point of T0,T1,T2,T3,the difference was statistically significant(P < 0.05);In observation group,PaCO2,PaO2,PaO2/FiO2 are obviously higher than the control group at the point of T0,T1,T2,T3,the difference was statistically significant(P<0.05);In observation group,TNF-?,IL-8,SP-B are obviously lower than the control group at the point of T2,T3(P<0.05);Postoperative pulmonary complications were significantly lower than that of contol group(P < 0.05).Conclusion: Lung ventilation strategy of low tidal volume ventilation,low positive end-expiratory pressure and lung recruitment protects lung with providing effective lung ventilation under a relatively lower airway pressure,improving lung compliance and oxygenation,as well as reducing inflammatory reaction and postoperative pulmonary complications during general anesthesia in pediatric laparoscopic surgery.