Effect Of Esophageal Pressure Gradient Positive End Expiratory Pressure On Postoperative Pulmonary Function And Pulmonary Complications In Laparoscopic Radical Colorectal Cancer

AIM:To evaluate the effect of esophageal pressure gradient positive end expiratory pressure on postoperative pulmonary function and pulmonary complications in laparoscopic radical colorectal cancer.METHODS:Ninety patients?aged more than sixty-five yr,ASA?or?,phsical status body mass index of 16-28 kg/m²?scheduled for elective laparoscopic radical resection of coloractal cancer were selected into this study.Patients were divided into three groups?n=30 each?using a random number table:control group?Group C?,fixed group?Group F?and esophageal pressure gradient titration PEEP group?Group P?.After induction of anesthesia,the patients were endotracheally intubated.The ventilator parameter were adjusted,with a tital volume8 ml/kg,inspiratory/expiratory ratio was 1.0:?1.5-2.0?and 60%oxygen was inhaled at 2 L/min.The end-tidal pressure of carbon dioxide was maintained at 35-40 mmHg.When began pneumoperitoneum,the PEEP of Group C were adjusted to 0 cmH₂O,the PEEP of Group F were adjusted to 5 cmH₂O and of Group P was determined by esophageal pressure monitoring to set the value of final PEEP:the value of transpulmonary of the end of expiratory were maintained at less than or equal to 10mmHg and gtater than 5 mmHg.After admision to the operation room?T₀?and at 1,3,5 days after operation(T_1d?T_3d?T_5d),forced expiratory volume in first second ?FEV₁?,forced tital capacity?FVC?,and maximal volume?MVV?were mesured,atrial blood samples were collected for blood gas analysis.aterial carbon dioxide pressure?PaCO₂?and aterial oxygen pressure?PaO₂?were recorded,andPaO₂/FiO₂was calculated.Clinical pulmonary infaction Score?CPIS?as assessed at T₁,T₂,and T₃.The rate of post-oprative pulmonary complications?PPC??including atelectasis?pneumothorax?respiratory failure?pneumothorax?pleural effusion?bronchospasmand respiration pneumonitis?were recorded.Time point of each observation index as following:before anesthesia?T₀?,after anesthesia induction but before the operation?T₁?,half hour after?T₂?,one hours after pneumoperitoneum?T₃?,one half hours postoperatively?T₄?,two hours postoperatively?T₅?and the end of opreation?T₆?.The values of MAP?HR?Pplat were also recorded at each times.Analyze the change of each time point and each index compared with the time before anesthesia?T₀?.RESULTS:1.The preoperative basic information of the patient:There was no significant difference in preoperative basic clinical information?including operation time,duration of anesthesia and extubation time?in the three groups?P>0.05?.2.The change of vital signs:Compared with T₀,the MAP and HR values of each group increased significantly in T₁-T₆of the three groups?P>0.05?.3.The changes of intraoperative resbiratory mechanics parameter:Compared with T₁,the Pplat and Pmean values of each group increased significantly?P<0.05?in T₃-T₆group,and increased significantly in P group and F group at T₂-T₄,and decreased significantly in Cydn?P<0.05?;compared with F group,P plat decreased at T₂-T₅,without statistical difference?P>0.05?.4.Comparison of the important standard at each time point in the three groups.?1?Campered with the baseline of FEV₁,FVC,MVV,PaO₂,P/F at T₀,FEV₁,FVC,MVV,PaO₂,P/F were significantly decreased at the time point(T_1d?T_3d?T_5d)in the all three groups?P<0.05?.?2?Compared with group C,FEV₁,FVC,MVV,PaO₂,P/F were significantly decreasedat the time point(T_1d?T_3d?T_5d)in group P and group F,while clinical pulmonary infaction score and the occurence of pulmonary camplications were obvious increased in group P and group F?P<0.05?.?3?Compared with group F,FEV₁,FVC,MVV,PaO₂,P/F were significantly decreasedat the time point(T_1d?T_3d?T_5d)in group P,while clinical pulmonary infaction score and the occurence of pulmonary camplications were obvious increased in group C.?P<0.05?.CONCLUSION:Esophageal pressure oriented PEEP can significantly improve postoperative lung ventilation function,which can decrease the rate of pulmonary coomplication in patients requiring laparoscopic radical resection during colorectal cancer.