The Clinicil Application Of Permissive Hypercapnia In Pneumothorax Operation On COPD Patients

Objective:Through observing the application of permissive hypercapnia on patients with chronic obstructive pulmonary disease?COPD?,the pulmonary protective effects of ventilation strategies in the pulmonary bulla resection operations on COPD patients was investigated,which might provide medical advice for the choice of a reasonable ventilation strategy for COPD patients with bullas or pneumothorax.Methods:30 COPD patiens?with one-lung ventilation?were selected as subjects,all of which were diagnosed according to the COPD guidlines of the Chinese Medical Association and chose to have pulmonary bulla resection operations in our hospital.The operation time should be in COPD remission period or after effective control of pulmonary infection.The 30 subjects were divided into two groups at random:group H and group C?the control?.The carbon dioxide pressure of Group H in one lung ventilation?OLV?was maintained at 50⁶5mmHg.And the carbon dioxide pressure of Group C in OLV was maintained at 35⁴5mmHg.The MAP,HR,peak inspimtory pressure?PIP?,tidal volume and Pplat were observed and recorded 1 min before OLV?T₁?,30 min after OLV?T₂?and 30 min after the lung dilated,and the Cdyn was calculated;the arterial blood gases,respiratory index?RI?and the concentrations of IL-6 and IL-8 in serum at T₁,T₂ and T₃ were testd and calculated.Results:The age differences,gender ratio,height,weight,anesthesia time and surgery time were not statistically significant?p>0.05?.The comparison of MAP and HR variation of the two groups at different time periods was not statistically significant?p>0.05?.The PIP,Pplat,RI and Cdyn differences of both groups at T₁ and the PIP and MAP differences at T₃ were not statistically significant.The PIP,Pplat and RI at T₂ were significantly higher than those at T₁,while Cdyn at T₂ was significantly lower than that at T₁,and the difference was statistically significant?p<0.05?.Compared with Group C,Group H had much lower PIP and Pplat at T₂ and evidently lower RI at T₂and T₃,and much higher Cdyn at T₂ and T₃,and the differences were statistically significant?P<0.05?.The IL-6 and IL-8 differences of the two groups at T₁ were not statistically significant.The IL-6 and IL-8 of both groups at T₂ were much higher than those at T₁.The differences had statistical significance?p<0.05?,and Group C showed more distinctly higher IL-6 and IL-8 than Group H,and the difference was statistically significant?p<0.05?.There was no statistically significant differences in the respiratory recovery time,conciousness time,extubation time and postoperative hospitalization time between the two groups?P>0.05?.Conclusion:The application of permissive hypercapnia in pneumothorax operation on COPD patients can decrease airway pressure and resistance,reduce the damage to the pulmonary diffusion function and increase Cdyn during OLV.It can also reduce the release of inflammatory cytolines during the OLV period,thus alleviate the inflammatory reaction of lung tissue.