Ventilation On Lung Function In Patients Undergoing Thoracoscopic Radical Resection Of Lung Cancer

Purpose:In order to provide a clear surgical field for thoracoscopic surgery,one-lungventilation is often used.One-lung ventilation model as a kind of physiological way of ventilation,inevitably increase the difficulty of perioperative airway management,and increases the risk of perioperative lung injury in patients.This study intends to compare the effect of 1:1 ratio and 1:2ratio on lung fuction in patients who undergoing thoracoscope radical resection of lung cancer and aim to provide a clinical reference for intraoperative airway management need for patients who need one-lung ventilation.Methods:Select 60 cases of patients who are going to accept thoracoscope radicalresection of lung cancer,all genders,age 45 to 60 years old,BMI18.5²8,ASA?^?level.After anesthesia induction,the patients were randomly divided into two groups:group E?30cases?;30 cases in group C.In both groups,100%FiO₂ was used for preoxygenation.After the completion of double-chamber endotracheal intubation,the respiratory ratio was set according to the random groups.Two-lung ventilation was performed till lateral position.During the whole mechanical ventilation process,volume controlled ventilation?VCV?was performed in both groups.Tidal volume of 6⁸ml/kg,and the inhalation/exhalation ratio?I:E?of group E was set as1:1,and that of group C was set as 1:2,PEEP 3cmH₂O and FiO₂ were set as 60%,respiratory frequency was adjusted to maintain P_ETCO₂ at 30⁴5mm Hg,and anesthesia depth was adjusted to maintain bispectral index?BIS?of eeg at 40⁵0.Time points of intraoperative sample collection and monitoring indicators:berore one-lung ventilation?T₁?;One-lung ventilation for 60min?T₂?;One-lung ventilation for 90min?T₃?.Intraoperative observation indexes:?1?pulse oxygen saturation?SpO₂?:SpO₂ is observed dynamically during operation,and the study of this case will be terminated once SpO₂<90%;?2?heart rate?HR?,mean arterial pressure?MAP?,central venous pressure?CVP?,end-expiratory partial CO₂ pressure(P_ETCO₂),Ppeak,Pplat,and Compl were recorded at three time points;?3?radial artery blood was extracted at three time points for blood gas analysis,and arterial partial pressure of oxygen?PaO₂?,arterial partial pressure of carbon dioxide?PaCO₂?,and alveolar-arterial partial pressure of oxygen(P_A-aO₂)were recorded.And 4ml center venous blood was extracted at three time points,The upper plasma was extracted after central venous blood centrifuged at 3000 RPM for 10 minutes and then stored in-80?refrigerator,the plamsa was used to determin the concentration of IL–6;?4?pulmonary fractional flow rate?Qs/Qt?%,respiratory index?RI?and dead volume?Vd/Vt?were calculated according to the above indexes.Results:?1?Preoperative general conditions of the two groups were compared,and thedifference was not statistically significant?P>0.05?.There was no significant difference in HR,MAP and CVP between the two groups at the same time point during the operation?P>0.05?.Intraoperative HR,MAP and CVP of the same group were compared at different time points,and the difference was not statistically significant?P>0.05?.?2?Compared with T₁,Ppeak and Pplat were increased at T₂ and T₃,while Compl was decreased in both groups,with statistically significant differences?P<0.05?.Compared with T₂,there was no statistically significant difference in Ppeak,Pplat and Compl at T₃?P>0.05?.At T₁,there was no significant difference in Ppeak,Pplat and Compl between the twogroups?P>0.05?.At T₂ and T₃,Ppeak and Pplat in group C were higher than those in group E,and Compl were lower than those in group E,with statistically significant differences?P<0.05?.?3?Compared with T₁,RI and Qs/Qt at time points T₂ and T₃ all increased in the samegroup during surgery,and the difference was statistically significant?P<0.05?.RI and Qs/Qt at the time point T₃ were both increased in the same group during the operation compared with that at the time point T₂,and the difference was statistically significant?P<0.05?.At T₁,RI and Qs/Qt in group C were higher than those in group E,and the difference was not statistically significant?P>0.05?.At time T₂ and T₃,RI and Qs/Qt in group C were significantly higher than those in group E,and the difference was statistically significant?P<0.05?.Compared with T₁,Vd/Vt increased at T₂ in group C,and the difference was notstatistically significant?P>0.05?;Vd/Vt increased at T₃,and the difference was statistically significant?P<0.05?.There was no statistically significant difference in Vd/Vt at three moments in group E?P>0.05?.At the time of T₁,there was no statistically significant difference in Vd/Vt between the two groups?P>0.05?.At time T₂ and T₃,Vd/Vt of patients in group C was significantly higher than that in group E,and the difference was statistically significant?P<0.05?.?4?Compared with T₁,intraoperative il-6 was increased at T₂ and T₃ in the same group,and the difference was statistically significant?P<0.05?.Compared with the T₂ moment,the intraoperative il-6 level was increased at T₃ time point in the same group,and the difference was statistically significant?P<0.05?.At time point T₁,intraoperative il-6 of patients in group C was higher than that in group E,but the difference was not statistically significant?P>0.05?.At time points of T₂ and T₃,intraoperative il-6 of patients in group C was higher than that in group E,and the difference was statistically significant?P<0.05?.Conclusion:In thoracoscopic lung cancer radical resection,when volume control ventilation mode is adopted,1:1 inhalation ratio is compared with 1:2,1:1 inhalation ratio can reduce airway peak pressure and airway platform pressure,improve lung compliance,reduce intrapulmonary shunt,improve oxygenation,and reduce plasma il-6 concentration without causing hemodynamic changes.