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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.
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Objective To analyze the clinical effect of Ivor-lewis esophageal carcinoma radical surgery on the treatment of esophageal cancer. Methods 50 patients with esophageal cancer treated in our hospital from August 2015 to April 2017 were reviewed by dividing them into 2 groups using 1:1 random number method, with 25 patients in each group. The control group received thoraco-abdominal three-cision esophageal cancer radical resection. The study group received Ivor-lewis esophageal cancer radical surgery. The treatment effects such as complications, length of stay, intraoperative blood loss and operation time in the two groups of patients were observed and compared. Results The total incidence of complications in the two groups were compared. The total incidence of complications in the study group (12％) was lower than that of the control group (32％). The data was statistically significant (P＜0. 05). The hospital stay, oral feeding time, nasogastric tube length, ICUtime, number of lymph node dissections, intraoperative fluid volume and blood loss, and operation time in the study group were lower than those of the control group and the difference was statistically significant (P＜0. 05). Conclusion Ivor-lewis esophageal cancer radical surgery can be given in the clinical treatment of esophageal cancer, which can shorten the operation time, reduce blood loss, promote postoperative recovery, with low complications, and then improve the prognosis of the disease, promote recovery. This surgical method is effective and safe, and is worthy of promotion.
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Objective To observe the effect of ketamine at low dose on inflammatory mediators during one lung ventilation and postoperative depression-like mood in patients with esophageal cancer radical surgery. Methods 60 patients who underwent esophageal cancer radical surgery were randomly divided into ketamine group(K)and control group(C). The patients in group K was injected with ketamine at a dose of 0.5 mg/kg at the time of anesthesia induction,then continuous infused with ketamine at a dose of 0.25 mg/(kg · h)for 30 minutes. Patients in group C:saline was given .Then concentrations of TNF-α,IL-6,IL-10 and PHQ-9 scores at different time points were evaluated. Results The PHQ-9 scores of the patients in K group at the 5 d after operation was significantly lower than that at the 1d before operation(P<0.05);The PHQ-9 scores in group K were decreased ob-viously than that those in group C(P<0.05). The concentration of serum TNF-α,IL-6 and IL-10 were significantly increased after T1 time of the two groups(P<0.05);Compared with group C,there was no statistical difference in the levels of TNF-α,IL-6 and IL-10 in group K at T2 and T3 time(P<0.05).Conclusion Low dose ketamine has no obvious effect on the concentration of blood TNF-α,IL-6 and IL -10 during one lung ventilation in patients with esophageal cancer radical surgery ,but it may alleviate postoperative depression-like mood.
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Objective To observe the effect of ketamine at low dose on inflammatory mediators during one lung ventilation and postoperative depression-like mood in patients with esophageal cancer radical surgery. Methods 60 patients who underwent esophageal cancer radical surgery were randomly divided into ketamine group(K)and control group(C). The patients in group K was injected with ketamine at a dose of 0.5 mg/kg at the time of anesthesia induction,then continuous infused with ketamine at a dose of 0.25 mg/(kg · h)for 30 minutes. Patients in group C:saline was given .Then concentrations of TNF-α,IL-6,IL-10 and PHQ-9 scores at different time points were evaluated. Results The PHQ-9 scores of the patients in K group at the 5 d after operation was significantly lower than that at the 1d before operation(P<0.05);The PHQ-9 scores in group K were decreased ob-viously than that those in group C(P<0.05). The concentration of serum TNF-α,IL-6 and IL-10 were significantly increased after T1 time of the two groups(P<0.05);Compared with group C,there was no statistical difference in the levels of TNF-α,IL-6 and IL-10 in group K at T2 and T3 time(P<0.05).Conclusion Low dose ketamine has no obvious effect on the concentration of blood TNF-α,IL-6 and IL -10 during one lung ventilation in patients with esophageal cancer radical surgery ,but it may alleviate postoperative depression-like mood.