Effect Of Lung Protective Ventilation On Perioperative Lung Injury In Patients Undergoing Spinal Surgery

Objective:To investigate the effect of lung protective ventilation on perioperative lung injury in patients undergoing spinal surgery.Methods:Sixty patients?28 males,32 females,40-70 years old,ASA grade II or III?undergoing selective lumbar posterior decompression and fusion and internal fixation were selected and randomly divided into two groups?n=30?:lung protective ventilation group?group P?and conventional ventilation group?group C?,group P:V_T 6 ml/kg?PBW?,RR 15 times/min,Fi O₂:50%,I:E=1:2,PEEP=4 cm H₂O,and manual lung recruitment maneuver every hour;group C:V_T 10 ml/kg?PBW?,RR 12 times/min,Fi O₂:pulmonary dynamic compliance(C_dyn)were recorded at 5 minutes after tracheal intubation?T₁?,5 minutes after prone position?T₂?,3 hours after prone position?T₃?,5 hours after prone position?T₄?,5 minutes after supine position?T₅?.Blood gas analysis were recorded at T₁-T₅.The arterial oxygen partial pressure?P_aO₂?and arterial carbon dioxide partial pressure?P_aCO₂?were recorded,the oxygenation index?OI?and Alveolar arterial oxygen differential pressure?A-a DO₂?was calculated.Peripheral venous blood samples were collected 5 minutes after tracheal intubation?T₁?,5 minutes after supine position change?T₅?,and 2 days after operation?T₆?.The concentrations of secreted protein 16?CC-16?,soluble receptor of advanced glycation end product?s RAGE?and IL-8 of Clara cells were measured by ELISA.The incidence of pulmonary complications,including pneumonia,postoperative respiratory support and sepsis,severe sepsis,septic shock and death,were recorded within 7 days after operation.Results:Compared with T₁,serum CC-16,s RAGE,and IL-8concentrations were increased in both groups at T₅?P<0.05?;compared with T₅,serum CC-16,s RAGE,and IL-8 concentrations were decreased in both groups at T₆?P<0.05?.Compared with group C,the concentrations of serum CC-16,s RAGE,and IL-8 in group P decreased at T₅?P<0.05?,and the concentrations of serum CC-16,s RAGE decreased at T₆?P<0.05?.Compared with group C,P_peak decreased in group P at T₁-T₅?P<0.05?.Compared with T₁,?P<0.05?in group P;compared with group C,C_dyn increased at T₃-T₅ in group P?P<0.05?.Compared with T₁,OI decreased and A-a DO₂ increased in both groups at T₃-T₅?P<0.05?;compared with group C,OI increased in group P at T₁-T₅?P<0.05?,and at T₂-T₅,A-a DO₂ decreased?P<0.05?.The incidence of pneumonia in group P was significantly lower than that in group C within 7days after surgery?P<0.05?.Conclusions:Lung protective ventilation can reduce perioperative lung injury,improve lung dynamic compliance and oxygenation function,and reduce the risk of perioperative pulmonary complications.