Effect of permissive hypercapnia on perioperative pulmonary inflammatory response in patients undergoing thoracoscopic combined with laparoscopic esophagectomy / 中华内分泌外科杂志

ABSTRACT

Objective:To study the effect of permissive hypercapnia on pulmonary infection in patients underwent thoracoscopic combined with laparoscopic radical esophagectomy.Methods:From 2018 to 2020, 90 who patients underwent thoracoscopic laparoscopy combined with radical esophagectomy were divided into 3 groups by random who number table method, including 30 patients in experimental group 1, 30 patients in experimental group 2, and 30 patients in control group.PaCO 2 was maintained in the range of 56 mmHg-65 mmHg in experimental group 1, 46 mmHg-55 mmHg in experimental group 2 and 35 mmHg-45 mmHg in control group. The peak airway pressure (Ppeak) , lung dynamic compliance (Cdyn) and oxygenation index (OI) were observed and compared among the three groups after endotracheal intubation (T1) , 30 min after right artificial pneumothorax (T2) and 30 min after right lung recruitment (T3) ;The clinical pulmonary infection score (CPIS) , serum procalcitonin (PCT) on the 1st, 4th and 7th day after operation were analyzed and compared. Results:At T2, observation group A had the highest dynamic lung compliance (25.13 ± 5.70 vs 22.28 ± 4.26 vs 19.99 ± 4.36), the fastest heart rate (102.04 ± 10.91 vs 96.46 ± 9.91 vs 92.28 ± 8.08) and the lowest airway pressure (17.62 ± 1.79 vs 18.96 ± 1.90 vs 20.39 ± 1.71) ( P < 0.05). Observation group A had the lowest CPIS on the 1st, 4th and 7th day after operation compared with observation group B and control group (1.12±0.77 vs 1.71±0.90 vs 2.64±1.07) (6.08±1.20 vs 7.43±1.10 vs 8.31±1.55) (1.69±1.12 vs 2.32±0.98 vs 3.44±1.25) ( P<0.05) . Conclusion:Permissive hypercapnia can reduce airway resistance, improve lung compliance and reduce the risk of postoperative pulmonary infection.