肺保护性通气策略对老年患者腹腔镜结直肠癌手术的氧合功能及血浆炎症介质水平的影响.

Objective: To investigate the effect of lung protective ventilation strategy on pulmonary oxygenation function and serum inflammatory mediators in elderly patients undergoing laparoscopic colorectal cancer surgery. Methods: 50 elderly patients undergoing elective laparoscopic colorectal cancer radical operation were classified by ASA（American Society of Anesthesiologists Physical Assessment Grade） Ⅰ-Ⅱ and aged over 60 years. They were divided into two groups by random number table: VCV group and PCV group. During mechanical ventilation under general anesthesia, the VCV group adopted the volume-controlled ventilation mode,and the tidal volume was set to 8 m L/kg PCV group adopted the lung protective ventilation strategy. Tidal volume was set to 6 m L/kg and5 cm H2O positive end expiration pres sure（PEEP）, and manual pulmonary resuscitation was given every 30 minutes after pneumoperitoneum Hemodynamic parameters and respiratory mechanics indexes were recorded at 5 minutes before pneumoperitoneum（T0）, at 5 minutes after pneumoperitoneum（T1）, at 30 minutes after pneumoperitoneum（T2）, at 60 minutes after pneumoperitoneum（T3） and at 120 minutes after pneumoperitoneum（T4） stopped at 10 minutes after pneumoperitoneum. Blood gas was extracted at T0, T4 and leaving PACU, and oxygenation index（OI） was calculated. Intravenous blood was taken at one day before operation, at T4 and one day after operation to detect the levels of CRP and IL-6 in plasma. Results: Compared with VCV group, PCV group had lower airway pressure at T4, T5 and higher lung compliance at T4, T5（P<0.05）. There was no significant difference in hemodynamic parameters between the two groups. Compared with VCV group, PCV group had a higher oxygenation index when they left PACU（P<0.05）, IL-6 and CRP in PCV group was lower at one day after operation（P<0.05）. Conclusion: Pulmonary protective ventilation strategy can improve the pulmonary oxygenation function, reduce the release of inflammatory mediators and the occurrence of lung injury in elderly patients [ABSTRACT FROM AUTHOR]