Effect of lung protective ventilation on postoperative pulmonary complications in elderly patients treated with laparoscopic surgery

ObjectiveTo study the effects of lung protective ventilation on postoperative pulmonary complications(PPCs) in elderly patients treated with laparoscopic surgery.

MethodsEighty colorectal carcinoma patients scheduled by laparoscopic radical resection were randomly divided into the lung protective ventilation group(group P) and control group(group C)(40 cases each group).Before general anesthesia induction(T₀), after 5 minutes of intubation(T₁), post-pneumoperitoneum 1 hour(T₂), at the end of operation(T₃), after 2 hours of extubation(T₄) and postoperative 24 hours(T₅), the blood gas analysis of radial artery was carried out.The intraoperative respiratory mechanical index and plasma neutrophil elastase(NE) concentration at the beginning and end of operation were recorded.The postoperative 7 days pulmonary complication and its score were recorded and analyzed using the clinical pulmonary infection score(CPIS), and the number of death after 30 days of operation were calculated.

ResultsThe differences of the value of PaO₂/FiO₂ at T₀, T₁, T₂ and T₄ between two groups were not statistically significant(P>0.05), and which in group C were lower than that in group P at T₃ and T₅(P < 0.05).The differences of the value of PaO₂ at T₀, T₁ and T₅ between two groups were not statistically significant(P>0.05), and which at T_2-3 and T₄ in group C were lower and higher than that in group P, respectively(P < 0.01).The pH value at T₀, T₁ and T₅ and T_2-4 in group C was lower and higher than that in group P, respectively(P < 0.05 to P < 0.01).Compared with T₀, the PaO₂/FiO₂ at T_3-5 decreased in group C, and the PaO₂/FiO₂ in group C at T_4-5 was higher than that at T₀.Compared with T₀, the PaO₂/FiO₂ at T_3-4 decreased in group P, and the PaO₂/FiO₂ in P group at T_2-4 was higher than that at T₀(P < 0.05).The PaO₂/FiO₂ and PaCO₂ in group P at T₅ basically restored to the preoperative level(P>0.05), and the pH value in group C at T₅ and P group at T_4-5 decreased(P < 0.05).The differences of the Ppeak, Pmean and Cdyn at T₁ between two groups were not statistical significance(P>0.05), and the Ppeak, Pmean and Cdyn in group P were higher than those in group C(P < 0.05).Compared with at T₁, the Ppeak and Pmean increased, and the Cdyn significantly decreased in two groups at T₂(P < 0.05).Compared with T₀, the NE levels in two groups increased at T₃(P < 0.01), the difference of the NE level at T₀ between two groups was not statistically significant(P>0.05), and the level of NE in group P was lower than that in group C at T₃(P < 0.01).The differences of the incidence rate of pulmonary complications within 7 days of operation and postoperative hospitalization time between two groups were not satistically significant(P>0.05).Compared with first day after operation, the CPIS scores in two groups decreased at seventh day after operation(P < 0.01), and the CPIS score in group C at seventh day after operation was lower compared with P group(P < 0.01).

ConclusionsLung protective ventilation in elderly colorectal carcinoma patients treated with laparoscopic radical resection can improve the early postoperative oxygenation, alleviate lung injury, and ensure the safety of patients.