Clinical Observation Of Perioperative Lung Protection With Dexamethasone During Thoracoscopic Lobectomy

Objective: To observe the protective effect of dexamethasone on the lungs of thoraco-scopic lobectomy patients and provide new ideas for perioperative lu ng protection.Methods: Sixty patients with inclusion criteria were selected and randomly divided into control group and observation group,and each group was 30 cases.The observation group was given intravenous injection of dexamethasone(0.5mg/kg)Before induction of anesthesia.The control group was given routine treatment.After lobectomy by three-hole laparoscope in two groups of patients,the levels of neutrophil(NEUT),c-reactive protein(CRP),partial pressure of oxygen(PO2),partial pressure of carbon dioxide(PCO2)were detected respecti-vely at preoperative 60min(T1),postoperative 30min(T2),postoperative 2h(T3),removal of tracheal intubation(T4)and the oxygen concentrations of various periods were recorded.The formula method was used to calculate alveoli-arterial oxygen pressure(A-a DO2),respiratory index(RI),oxigenation index(OI).At the same time,the Tidal volume(VT),Positive End Expiratory Pressure(PEEP)and Plat pressure were recorded at T2,T3 and T4,and the formula method was used to calculate the static compliance(Cst).The operation modes,operation time,blood loss,the duration of mechanical ventilation,extubation time,chest drainage,chest tube extubation time,postoperative complications and postoperative hospital days were recorded.Activity and resting postoperative pain was evaluated by the visual analog scale(VAS)at 12 h,24h,48 h and 72 h.Results: 1.The general situation of two groups of patients: There was no significant difference in sex,age,disease constitution,resection site,number of lymph node dissection,operation time,blood loss,tidal volume and tracheal extubation between two groups(P>0.05).2.Comparison of NEUT and CRP between two groups at different time points: There was no significant difference between two groups at T1;The two groups of NEUT and CRP at T2,T3,and T4 were higher than those at T1(P<0.05).The levels of NEUT and CRP of the control group were significantly higher than the observation group at T2,T3 and T4(P<0.05).3.Changes in respiratory function parameters of two groups of patients: The two groups of A-a DO2,RI and OI had no significant differences at T1(P>0.05);The two groups of A-a DO2,RI and OI were significantly higher at T2,T3 and T4 than T1(P<0.05);The levels of A-a DO2 and RI in the observation group were significantly lower than the control group at T2,T3 and T4(P<0.05);The level of OI in the observation group was significantly higher than the control group at T2,T3 and T4.4.Cst comparison of two groups: The level of Cst in the observation group was significantly greater than the control group at T3 and T4(P<0.05).5.Comparison of postoperative pain score between two groups: Postoperative resting pain scores in observation group were lower than those in control group at 12 h,24h,48 h,72h and statistically significant at 72h(P<0.05);Postoperative active pain scores in observation group were lower than those in control group at 12 h,24h,48 h and 72h(P<0.05).6.Comparison of clinical data between two groups: Thoracic drainage volume,drainage time and hospital days in the observation group were significantly less than the control group(P<0.05);postoperative complications were mainly pneumonia and atelectasis,The incidence of complications in the control group was higher than that in the observation group(36.67% vs 13.33%)(P<0.05).7.ALI and ARDS did not occur at T1 between the two groups.The incidences of ALI in observation group were lower than those in control group(23.33% vs 33.33%;6.67% vs 16.67%;3.33% vs 26.67%)at T2,T3 and T4,and the difference was statistically significant at T4(P<0.05).The incidence of ARDS in the observation group was lower than those in control group(6.67% vs 16.67%;3.33% vs 26.67%;0 vs 6.67%)at T2,T3 and T4,and the difference was statistically significant at T3(P <0.05).Conclusion: 1.Dexamethasone can reduce NEUT quantity and CRP level,improve respiratory function,reduce the occurrence of lung injury,so it has a protective effect on pulmonary function of patients undergoing thoracoscopic lobectomy.2.Dexamethasone can reduce the severity of postoperative pain,reduce drainage volume in the chest cavity,and shorten drainage tube extubation time,postoperative hospital days and reduce postoperative complications.Therefore,it has certain clinical,practical and instructive significance on perioperative lung protection and postoperative rehabilitation.