The Effects Of Protective Lung Ventilation On Postoperative Delirium In Patients With Lung Cancer Undergoing Thoracoscopic Surgery

Objective To investigate the effects of protective lung ventilation?PLV?strategy on postoperative delirium in patients with lung cancer undergoing video-assisted thoracoscopic lung surgery?VATS?.Methods A total of one hundred patients who underwent elective thoracoscopic radical resection of lung cancer,aged 50 years or elder,were included in the left or right lung lobe resection.ASA I^III,NHYA I^?.All patients were given total intravenous anesthesia,one-lung ventilation?OLV?under double-lumen bronchial catheter,and the duration of one-lung ventilation time was expected to be 1³ hours.Patients were divided into two groups by random number method,52 cases in the protection group and48 cases in the control group.The protective lung ventilation group,two-lung ventilation,tidal volume?VT?8 ml/kg and positive end expiratory pressure?PEEP?5cmH₂O,low inhaled oxygen concentration?FIO₂?0.7,respiratory rate?RR?10¹2times/min,adjust respiratory rate and maintain PaCO₂ 35⁴5mmHg as possible as we can,but less than 60mmHg,inhalation to exhalation ratio is 1:2.One-lung ventilation?OLV?,VT 6 mg/kg+PEEP 5cmH₂O+lung recruitment maneuver(time points,the breathing circuit disconnection,the end of one-lung ventilation,and the end of the operation.Continuous lung inflation method,P_peak is raised to 30 cmH₂O within 3 to 5 s for 30s,repeated 2 to 3 times,and the original ventilation is resumed),FIO₂ 0.7,RR12¹6times per min,adjust the respiratory rate to maintain PaCO₂ 35⁴5mmHg,the ratio of inhalation to exhalation is 1:2.In the control group,double lung ventilation was set as VT 10 ml/kg,PEEP 0,FIO₂ 1.0,RR 10¹2 times/min,adjust the respiratory rate to maintain PaCO₂ 35⁴5mmHg,and the ratio of inspiratory and expiratory was 1:2.One-lung ventilation,VT 8 ml/kg,PEEP 0,FIO₂ 1.0,RR 12¹6 times/min,adjusted respiratory rate and maintain PaCO₂ 35⁴5mmHg,inspiratory and expiratory ratio is1:2.Both groups adopted the multi-model precise anesthesia management strategy,including bispectral index?BIS?to monitor anesthesia depth,target-controlled infusion of propofol injection?TCI?,continuous infusion of remifentanil and cis-atracurium,and sufentanil were injected intermittently,the anesthetics may increased or decreased according to the patient and the operation,intraoperative warming and limited fluid infusion,intraoperative monitoring of cerebral oxygen Saturation?rSO₂?,multimodal analgesia was taken.Intraoperative oxygen saturation?SpO₂<90%?and cerebral oxygen saturation?rSO2<55%?were recorded.In addition,arterial blood gas tests were compared between the two groups at the time points,before the operation and the basal blood gas was not inhaled,after one-lung ventilation 1 hour,and the postoperative extubation deoxygenation for 5 minutes.The comparison of intraoperative airway pressure P_peak and P_plat were recorded.The primary outcomes were the incidence of postoperative delirium?POD?and postoperative pulmonary complications?PPCs?.The time of extubation,off-bed activity time,chest tube removal time,the duration of hospitalization after surgery are all analysed.Postoperative delirium was determined by consciousness disturbance assessment?CAM?,and the patients were followed up until discharge.Results There were no statistically significant differences between the two groups in preoperative general data such as age,gender,ASA classification,preoperative lung functions,and preoperative hemoglobin?P>0.05?.There was no statistically significant difference in intraoperative blood loss,infusion volume,duration of OLV and operation?P>0.05?.ComparedwithCVgroup,PVgrouphadhigherPaO₂ and OI?P<0.05?,intraoperative low SpO₂<90%and lower rSO₂ incidence and duration were lower?P<0.05?,the incidence of postoperative POD and PPCs was lower after surgery?P<0.05?,and the time of extubation was shortened?P<0.05?,and the difference in hospital stay was not statistically significant?P>0.05?.Conclusion Protective lung ventilation in patients undergoing thoracoscopic radical lung cancer surgery,the intraoperative oxygen saturation and cerebral oxygen saturation are higher,and the incidence of postoperative delirium and postoperative pulmonary complications is lower,improve the quality of life of patients and provide a reference for clinical.