Effect of lung protection ventilation on postoperative lung complications in patients with esophageal cancer
10.3969/j.issn.1007-1989.2018.06.012
- VernacularTitle:肺保护通气对食管癌患者术后肺部并发症的影响
- Author:
Xiao-Yan DENG
1
;
Li-Na XIAN
Author Information
1. 海南医学院第一附属医院 重症医学科
- Keywords:
thoracic laparoscopic esophageal cancer radical surgery;
lung protection ventilation;
pulmonary function
- From:
China Journal of Endoscopy
2018;24(6):64-70
- CountryChina
- Language:Chinese
-
Abstract:
Objective?To investigate the effect of lung protection ventilation on postoperative pulmonary complications in patients with esophageal cancer.?Methods?98 patients underwent thoracoscopic laparoscopic esophagectomy for radical resection from January 2014 to January 2017 were enrolled in this study. Patients were divided into observation group (n = 49) and control group (n = 49) randomly. Two groups of patients underwent intraoperative single lumen tracheal catheter supplemented with CO2 pneumothorax. The control group received conventional ventilation. The protective group of patients in the observation group were given protective ventilation. The time of tracheal intubation after 10 min (T1); single lung ventilation 1 h (T2); at the end of surgery (T3); 24 h (T4) after pulmonary function parameters, inflammatory response, blood gas were analyzed. The patients were divided into recurrence group (n = 24) and non-recurrence group (n = 74), pulmonary complications and its related factors were analyzed according to whether the patient had recurrent or not pulmonary complications after recurrent (n = 24) or non-recurrent (n = 74).?Results?Pplat, airway peak pressure (Ppeak), airway resistance (Raw), interleukin-6 (IL-6), and interleukin-8 (in the two groups) at time T1. Interleukin-8, (IL-8), soluble intercellular adhesion molecule-1 (Sicam-1), partial pressure of carbon dioxide in artery (PaCO2), partial pressure of oxygen There was no significant difference in the index of oxygen, PaO2, and oxygenation index (PaO2/FiO2) (P > 0.05); the changes in Pplat, Ppeak, and Raw in the control group between T1 and T3 were significantly greater than those in the observation group. The changes of IL-6, IL-8, and Sicam-1 in the control group from T1 to T4 were significantly greater than those in the observation group (P < 0.05). T1 to T4 The change of PaO2 in the control group was significantly greater than that in the observation group, and the difference was statistically significant (P < 0.05). There were multiple pulmonary complications in some patients in both groups. There were 18.36% in the observation group and 30.61% in the control group combined with various types of pulmonary complications. The difference was statistically significant (P < 0.05). Preoperative smoking, operation time, degree of radicalization, clinical pathological stage, lymphatic infiltration, microvascular infiltration, postoperative adjuvant chemotherapy, and pulmonary complications in patients undergoing radical surgery for esophageal cancer were closely related (P < 0.05).?Conclusion?Lung protection ventilation can relieve the thoracoscopic laryngeal esophageal cancer surgery in the airway resistance, pressure and inflammation, increased oxygen saturation, should strengthen the high risk of pulmonary complications in patients with monitoring, targeted prevention, reduce postoperative the incidence of pulmonary complications.
