Improvement of postoperative pulmonary function during general anesthesia for open abdominal surgery with lung protective ventilation strategy and alveolar recruitment maneuvers / 中国医师进修杂志

ABSTRACT

Objective To observe the improvement of postoperative pulmonary function and oxygen partial pressure during general anesthesia for open abdominal surgery with lung protective ventilation strategies and alveolar recruitment maneuvers. Methods Seventy patients who underwent selective open abdominal surgery were selected, and they were divided into standard ventilation group (tidal volume 8 ml/kg) and protective ventilation group (tidal volume 6 ml/kg, 5 cmH2O positive end-expiratory pressure, and alveolar recruitment maneuvers, 1 cmH2O=0.098 kPa) according to the random digits table method with 35 cases each. The airway pressure, blood pressure, pulse oxygen saturation (SpO2), end-tidal partial pressure of carbon dioxide (PETCO2) and adverse reactions were observed. The SpO2, partial pressure of O2 (PaO2) and pulmonary function before surgery and 1, 3, 5 d after surgery were measured. Results The respiratory rate, airway pressure and PETCO2 levels in protective ventilation group were significantly higher than those in standard ventilation group (12.3 ± 2.1) times/min vs. (10.2 ± 1.0) times/min, (15.1 ± 2.8) cmH2O vs. (13.5 ± 2.3) cmH2O, (34.6 ± 2.1) mmHg (1 mmHg=0.133 kPa) vs. (32.1 ± 1.4) mmHg, and there were statistical differences (P0.05). The SpO2 and PaO2 levels at 1, 3 d after surgery in protective ventilation group were significantly higher than those in standard ventilation group0.951 ± 0.018 vs. 0.936 ± 0.016 and 0.964 ± 0.018 vs. 0.949 ± 0.018, (74.8 ± 6.8) mmHg vs. (65.0 ± 6.2) mmHg and (79.6 ± 6.0) mmHg vs. (70.6 ± 5.3) mmHg, and there were statistical differences (P<0.05). The forced expiratory volume in 1 s (FEV1), percentage of the estimated value of FEV1, forced vital capacity (FVC) and percentage of the estimated value of FVC at 1, 3 and 5 d after surgery in protective ventilation group were significantly higher than those in standard ventilation group, the FEV1/FVC at 1 d after surgery was significantly higher than that in standard ventilation group, and there were statistical differences (P<0.05). Conclusions The lung protective ventilation strategy and alveolar recruitment maneuvers can improve the postoperative pulmonary function and oxygen partial pressure during general anesthesia for abdominal surgery. Low vital volume, appropriate positive end-expiratory pressure and recruitment maneuvers can protect the lung in general anesthesia patients.