Clinical value of lung protective ventilation strategy for thoracoscopic surgery in elderly patients with chronic obstructive pulmonary disease

  Objective  To observe the effect of protective ventilation strategy in thoracoscopic surgery on perioperative complications, pulmonary oxygenation level and expressions of serum inflammatory factors in elderly patients with chronic obstructive pulmonary disease under general anesthesia.

  Methods  A total of 112 elderly patients with chronic obstructive pulmonary disease were enrolled as study objects, and received total intravenous anesthesia and thoracoscopic surgeries. Afterwards, they were randomly divided into control group and observation group, with 56 cases in each group. The control group was given routine pulmonary ventilation (tidal volume from 8 to 10 mL/kg). The observation group was given pulmonary protection ventilation strategy (tidal volume from 5 to 6 mL/kg, positive end-expiratory pressure from 5 to 10 cmH₂O and plateau pressure < 30 cmH₂O). The incidence of perioperative complications and hospital stay after operation in the two groups were compared. Pulmonary oxygenation indicators including oxygenation index, ratio of forced expiratory volume in first second to forced expiratory volume(FEV₁/FVC), percentage of predicted FEV₁ (FEV₁%), alveolar-arterial oxygen partial pressure difference p_(A-a)(O₂), and end-expiratory partial pressure of carbon dioxidep_et(CO₂), serum inflammatory factors including serum inflammatory factors include interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and interferon-γ (INF-γ).

  Results  The total complication rate of the observation group was significantly lower, and the postoperative hospital stay was significantly shorter than that of the control group (P < 0.05). At 7 days after operation, the oxygenation index, FEV₁/FVC, FEV₁% and p_(A-a)(O₂) levels of the observation group were significantly higher than those of the control group, while the p_et(CO₂) level and serum IL-6, TNF-α and INF-γ levels of the observation group were significantly lower than those of the control group (P < 0.05).

  Conclusion  The application of lung protective ventilation strategy in minimally invasive surgery of elderly patients with chronic obstructive pulmonary disease under general anesthesia has high clinical value, which can significantly reduce the incidence of perioperative complications, improve the level of pulmonary oxygenation, inhibit the expression of serum inflammatory factors, and promote the rapid recovery of patients.