Study On Effect Of One-Lung Ventilation And Double-Lung Ventilation With Artificial Pneumothorax Combined With PCV And VCV On Oxidative Stress

Background and ObjectiveMechanical ventilation can ensure gas exchange and oxygenation maintenance after general anesthesia as a respiratory support method for general anesthesia patients,however it can also cause ventilator-induced lung injury?VILI?while maintaining ventilation.Nowadays the mechanism of VILI has not yet been clarified.The classic mechanisms of VILI include colotrauma,barotrauma,lung collapse injury,and biotrauma.In recent years,the biotrauma caused by mechanical ventilation is considered to be the core mechanism of VILI,and the damage caused by the imbalance of oxidative stress has gradually been valued by people.China is a high-risk area of esophageal cancer.Surgery is considered to be the most common and effective method for the treatment of esophageal cancer.One-lung ventilation is a commonly used method of ventilation in esophageal cancer surgery.However,one-lung ventilation is a non-physiological ventilator,which causes imbalance of ventilation and blood flow and leads to hypoxemia.In recent years,it has been proposed that single-lumen endotracheal intubation combined with artificial carbon dioxide pneumothorax in thoracoscopic esophageal cancer radical surgery can reduce the imbalance of ventilation and blood flow and improve oxygenation during operation.However,the effects of two types of ventilation on oxidative stress has not been reportedVolume controlled ventilation?VCV?is a commonly used in clinical practice.However,VCV often causes lung injury due to high airway pressure in thoracic surgery.Therefore,pressure-controlled ventilation?PCV?has been mentioned again in recent years.However,there are few studies on the two ventilation modes in thoracoscopic surgery.The purpose of this study is to explore the effect of two ventilation modes?VCV and PCV?on the oxidative stress using one-lung ventilation or artificial pneumothorax with double-lung ventilation during radical thoracoscopic esophageal cancer surgery,in order to find suitable ventilation methods and models to reduce lung injury caused by mechanical ventilation,to improve the patient's lung function and enhance recovery after surgery.Materials and MethodsOne hundred fifty-two patients with ASA?^?patients of both sexes,aged46-64 yr,weight 50⁸0 kg,undergoing selective thoracoscopic esophageal cancer radical surgery were enrolled in this study.Divided into four groups according to the random number table method.The volume control OLV group?group VO?,capacity control artificial pneumothorax DLV group?group VD?,pressure control OLV group?group PO?,pressure control artificial pneumothorax DLV group?group PD?.Double-lumen endotracheal tubes was inserted into into group VO and PO,Single-lumen endotracheal tube was inserted into group VD and PD.After changing to the left lying position,in the group VO,mechanical ventilation parameters were set after OLV to make VT 5-6 mL/kg and PEEP 5 cmH2O;in the group VD,mechanical ventilation parameters were set after establishment of artificial pneumothorax DLV to make VT 5-6 mL/kg and PEEP 5 cmH₂O;in the group PO,mechanical ventilation parameters were set after OLV to make VT 5-6 mL/kg and PEEP 5 cmH₂O for 5 min under VCV,and then switched directly to PCV;in the group PD,mechanical ventilation parameters were set after establishment of artificial pneumothorax DLV to make VT 5-6 mL/kg and PEEP 5 cmH₂O for 5 minutes under VCV,and then switched directly to PCV.In OLV?group VO and group PO?,DLV?group VD and group PD?immediately?T1?,mechanical ventilation 60min?T2?and mechanical ventilation 90min?T₃?,gather the arterial blood of patients for blood gas analysis,and record PaO2,PaCO2.Calculate the Qs/Qt and RI at the corresponding time point according to the measurement results.Collect patient's central venous blood,measure SOD activity,MDA content and 8-iso-PGF_2?content according to kit instructions.At the same time,the patient's HR,MAP,PPV and vasoactive drug dosage were recorded.All results were statistically analysed by SPSS version 21.0 software.All values in line with the normal distribution were expressed as mean±SD,intragroup comparison using ANOVA,analysis of variance between multiple sets of measurement data using repeated measurement data,LSD-t method was used for all pairwise compatrison.P<0.05 was considered statistically significant.Results1.There was no statistically significant difference in the preoperative general conditions of the four groups of patients?P>0.05?;In the four groups of patients,MAP,PPV,HR were compared at the same time,and the difference was not statistically significant?P>0.05?;The same group of patients had no statistically significant difference between T₁,T₂ and T₃?P>0.05?,There was no significant difference in the doses of the four groups of patients at each time point?P>0.05?.2.Qs/Qt and RI:Intra-group comparison:Compared with T₁,the Qs/Qt and RI in the four groups at T₂ and T₃ increased significantly?P<0.05?;Compared with T₂time point,there was no significant difference in the Qs/Qt and RI between the four groups at T₃?P>0.05?;Comparison between groups:At T₁,there was no significant difference in the Qs/Qt and RI between the four groups?P>0.05?;At T₂ and T₃,the Qs/Qt and RI were highest in the VO group,and lowest in the PD group.The difference between the VD group and the PO group was statistically significant?P<0.05?,There was no significant difference between VD group and PO group?P>0.05?.3.Comparison of SOD,MDA,8-iso-PGF_2?:Intra-group comparison:Compared with T₁,SOD activity in all groups decreased significantly at T₂ and T₃,and serum MDA and 8-iso-PGF_2?content increased significantly?P<0.05?;Compared with T₂,there was no significant difference in serum SOD activity,serum MDA,and8-iso-PGF_2?among patients in each group at T₃?P>0.05?.Comparison between groups:At the T₁,there was no significant difference in serum SOD activity,serum MDA,and 8-iso-PGF_2?among patients in each group?P>0.05?;At T₂ and T₃,serum SOD activity was the lowest in the VO group,and serum MDA and 8-iso-PGF_2?were the highest,serum SOD activity was the lowest in the PD group,and serum MDA and8-iso-PGF_2?were the lowest,the difference between the VD group and the PO group was statistically significant?P<0.05?.There was no significant difference between VD group and PO group?P>0.05?.ConclusionIn thoracoscopic esophageal cancer radical resection,the use of mechanical ventilation with pressure-controlled artificial pneumothorax bilateral ventilation can reduce the pulmonary shunt,improve oxygenation,and reduce lung oxidative stress injury.