Effect of different ventilation modes on lung injury in patients performed with retroperitoneal laparoscopic surgeries
LA Jin1 TIAN Shou-yuan2 WANG Xin2 SU Xue-sen1 YUAN Xin1 ZHANG Rui1 LIU Shu-fang1 LI Chao1
1.Department of Anesthesiology,Shanxi Medical University,Shanxi Province,Taiyuan 030001,China;2.Department of Anesthesiology,the First Hospital of Shanxi Medical University,Shanxi Province,Taiyuan 030001,China
Abstract：Objective To compare the influence of pressure control ventilation–volume guaranteed (PCV-VG)and volume controlled ventilation (VCV)on lung injury in patients performed with retroperitoneal laparoscopic surgeries.Methods From August to December 2017,60 patients performed with retroperitoneal laparoscopic surgeries in our hospital were selected.They were divided into two groups by a random double-blinding:PCV-VG group (Pgroup)and VCV group (Vgroup)with 30 cases in each group.Ventilation was carried out based on the preset ventilation parameters.At T1-T4(5 min after tracheal intubation,30 min after pneumoperitoneum,90 min after pneumoperitoneum,and 30 min after pneumoperitoneum ending),the Ppeak,Pmean,and end-tidal carbon dioxide(PetCO2)were recorded,lung compliance at various times(Cd)was calculated,and the concentrations of plasma interleukin-6(IL-6),tumor necrosis factor-α (TNF-α),and soluble intercellular cell adhesion molecule-1 (sICAM-1)were monitored at each time by drawing arterial blood.The changes of respiratory mechanics parameters and the concentrations of IL-6,TNF-α and sICAM-1 were compared between the two groups.Results In group P,Pmean,Ppeak,plasma IL-6,TNF-α and sICAM-1 concentrations at T1-T4were significantly lower than those in group V(P＜0.05).In group P,the Cd values at T2,T3,T4were higher than those in group V (P＜0.05).Conclusion The PCV-VG mode can decrease the Ppeak and Pmean in patients undergoing retroperitoneal laparoscopic surgery,increase Cd values,and reduce plasma concentrations of IL-6,TNF-α and sICAM-1,and control the occurrence of lung injury to some extent.
喇锦;田首元;王鑫;苏学森;苑昕;张瑞;刘淑芳;李超. 不同通气模式对后腹腔镜手术患者肺损伤的影响[J]. 中国当代医药, 2018, 25(23): 60-63.
LA Jin;TIAN Shou-yuan;WANG Xin;SU Xue-sen;YUAN Xin;ZHANG Rui;LIU Shu-fang;LI Chao. Effect of different ventilation modes on lung injury in patients performed with retroperitoneal laparoscopic surgeries. 中国当代医药, 2018, 25(23): 60-63.
Nickkholgh A，Barro-Bejarano M，Liang R，et al.Signs of reperfusion injury following CO2pneumoperitoneum：an in vivo microscopy study[J].Surg Endosc，2008，22（1）：122-128.
[3]
Karapolat S，Gezer S，Yildirim U，et al.Prevention of pulmonary complications of pneumoperitoneum in rats[J].J Cardiothorac Surg，2011，6（1）：1-7.
[5]
Assad OM，El Sayed AA，Khalil MA.Comparison of volumecontrolled ventilation and pressure-controlled ventilation volume guaranteed during laparoscopic surgery in Trendelenburg position[J].J Clin Anesth，2016，34：55-61.
[6]
Ugurlucan M，Basaran M，Erdim F，et al.Pressure-controlled mechanical ventilation is more advantageous in the followup of patients with chronic obstructive pulmonary disease after open heart surgery[J].Heart Surg Forum，2014，17（1）：e1-e6.
[12]
Bellani G，Guerra L，Musch G，et al.Lung regional metabolic activity and gas volume changes induced by tidal ventilation in patients with acute lung injury[J].Am J Resp CritCare，2011，183（9）：1193-1199.
[13]
Terragni PP，Del Sorbo L，Mascia L，et al.Tidal volume lower than 6 ml/kg enhances lung protection：role of extracorporeal carbon dioxide removal[J].Anesthesiology，2009，111（4）：826-835.
[14]
Amato MBP，Meade MO，Slutsky AS，et al.Driving pressure and survival in the acute respiratory distress syndrome[J].New Engl.J.Med，2015，372（8）：747-755.
[15]
Masood A，Yi M，Lau M，et al.Therapeutic effects of hypercapnia on chronic lung injury and vascular remodeling in neonatal rats[J].Am J Physiol-Lung.C，2009，297（5）： L920-L930.
[16]
Protti A，Cressoni M，Santini A，et al.Lung stress and strain during mechanical ventilation：any safe threshold?[J].Am J Respir Crit Care Med，2011，183（10）：1354-1362.
[17]
Li TS，Zhao B，Wang C，et al.Regulatory effects of hydrogen sulfide on IL-6，IL-8 and IL-10 levels in the plasma and pulmonary tissue of rats with acute lung injury[J].Exp Boil Med，2008，233（9）：1081-1087.
[18]
Kira S，Daa T，Kashima K，et al.Mild hypothermia reduces expression of intercellular adhesion molecule-1 （ICAM-1）and the accumulation of neutrophils after acid-induced lung injury in the rat[J].Acta Anaesthesiologica Scandinavica，2005，49（3）：351-359.
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