Effects Of Lung Protective Ventilation Strategy On Lung Function And Inflammatory Factors During Abdominal Surgery In Obese Patients

ObjectiveTo observe the effect of lung protective ventilation strategy on lung function and inflammatory factors during abdominal surgery in obese patients.MethodsA total of 60 obese patients who underwent open abdominal surgery in the second clinical medical college of Qingdao university from January 2017 to September 2019 were selected as the research object.,the American Society of Anesthesiologists?American Society of Anesthesiologists,ASA?class I or II,BMI?Body Mass Index,BMI?of 30 to 35 kg/m²,were randomly divided into observation group and control group in the two groups,each group 30cases,anesthesia induction and maintain the same drug during,endotracheal intubation after mechanical ventilation.Observation group:Ventilation mode of anesthesia machine was set as Volume control ventilation?VCV?,compound end-expiratory pressure?PEEP?,PEEP=5cm H₂0,tidal Volume?VT?was set as 6 ml/kg,Respiratory Rate?RR?was adjusted,and P_ETCO₂?end-expiratory CO₂?was maintained from 35 to 45mmHg.Inhalation expiration?I?E?was set as1?2.During the operation,the lung was retented by manipulation once every 30min,and the lung was retented by manipulation once before the extraction of the airway catheter?40mmHg pressure,duration of 7?8s?.Control group:the ventilation mode of anesthesia machine was set as volume controlled ventilation,VT was set as 10 ml/kg,and P_ETCO₂?end-expiratory CO₂?was maintained at 35?45mmHg,PEEP values are not set,and I?E was set as 1?2.No pulmonary reconstruction was performed intraoperatively or prior to tracheal catheter extraction.Intraoperatively,monitoring of invasive arterial blood pressure?IBP?,heart rate?HR?,electrocardiogram?ECG?,oxygen saturation?SpO₂?,BIS?BIS?,end-expiratory CO₂(P_ETCO₂).Mean arterial pressure MAP and HR were recorded at five time points,namely,10min after admission?T0?,30min after anesthesia cannulation?T1?,60min after anesthesia cannulation?T2?,20min after anesthesia extubation?T3?,and 24h after operation?T4?.Tidal volume?VT?,respiratory rate?RR?,airway peak pressure?Ppeak?and airway plateau pressure?Pplat?at T1 and T2 were recorded.Inhaled oxygen concentration?FiO₂?at five time points of T0,T1,T2,T3 and T4 of patients in the two groups were recorded.Arterial blood gas analysis was performed by taking 2mL arterial blood at each time point.Arterial blood gas analysis indicators at each time point were recorded,including PH value,PaCO₂,PaO₂,A-aDO₂,OI and RI.5ml peripheral venous blood was extracted at five time points of T0,T1,T2,T3 and T4,and plasma concentrations of TNF-?,IL-6 and IL-8 were detected and recorded at each time point.ResultsThere were no statistically significant differences in age,gender,ASA classification,operation time,infusion volume and blood loss between the two groups?P>0.05?.There was no significant difference in MAP and HR between the two groups at each time point?P>0.05?.There were no statistically significant differences in blood gas indicators PH,PaCO₂,PaO₂,A-aDO₂,RI and OI between the two groups at time T0?P>0.05?,and no statistically significant differences in blood gas indicators PaO₂,A-aDO₂,RI and OI between the two groups at time T1,T2,T3 and T4?P>0.05?.PaCO₂ of the observation group at time points T1 and T2was higher than that of the control group,with statistically significant difference?P<0.05?.PH value of the observation group at time points T2 was lower than that of the control group,with statistically significant difference Statistically significant?P<0.05?,there was no statistically significant difference in PH value and PaCO₂ between the two groups at time points T3 and T4?P>0.05?.In the observation group,VT at time points T1 and T2 was significantly lower than that of the control group,with statistically significant difference?P<0.05?,while respiration rate was significantly higher than that of the control group,with statistically significant difference?P<0.05?.Ppeak and Pplat in the observation group were lower than those in the control group at time points T1 and T2,and the difference was statistically significant?P<0.05?.Two groups of patients at T0 time points TNF alpha,IL-8 and plasma concentration of IL-6 comparison difference has no statistical significance?P>0.05?,two groups of patients in T1,T2,T3,T4 time TNF alpha,IL-8 and the plasma concentration of the IL-6 are also higher T0 time points,statistical significance difference?P<0.05?,the observation group in T1,T2,T3,T4 time TNF alpha,IL-8 and IL-6 plasma concentrations are lower than the control group,difference has statistical significance?P<0.05?.ConclusionCompared with the traditional ventilation modes,lung protective ventilation strategies applied in obese patients with abdominal surgery under general anesthesia,can meet the demand of intraoperative ventilation and oxygenation and reduce airway peak pressure and airway platform,reduce intraoperative tumor necrosis factor alpha and interleukin-6inflammatory factor,interleukin-8-the release of inflammatory factors,so as to reduce lung injury caused by inflammatory factor,is advantageous to the obese patients who protect lung function.