Analysis of Respiratory Mechanisms in Chronic Obstructive Pulmonary Disease Patients Under the Effects of Penehyclidine Hydrochloride Combined with Continuous Positive Airway Pressure Ventilation

Abstract

Objective: Our aim was to evaluate the respiratory mechanical effects of penehyclidine hydrochloride combined with intraoperative pulmonary continuous positive airway pressure (CPAP) ventilation on pulmonary function and postoperative pulmonary complications in patients with chronic obstructive pulmonary disease (COPD) during one-lung ventilation. Methods: Eighty patients with COPD who underwent thoracoscopic surgery under general anesthesia were selected and their conditions were validated using chest X-rays. They were then divided into 4 groups in the light of the random number table (n = 20), the regular group (group-C), the penehyclidine hydrochloride group (Group-P), CPAP ventilation group (Group A) and combination group (PA group). All patients underwent mechanical ventilation after double lumen bronchial intubation, inhaled oxygen concentration 100%, oxygen flow 2 L/min, VT 6~8 ml/kg, RR 10~14 times/min, single lung ventilation (OLV) RR 12~16 times/min, maintaining PETCO2 40~45 mmHg. Before the endotracheal intubation, the P group and the PA group were intravenously infused with penehyclidine hydrochloride 0.01 mg/kg. After the start of the incision, each group was changed to OLV. During the OLV of groups A and PA, the lungs of the operation side were CPAP. The pressure is 2 cm H2O. The respiratory mechanics parameters (Ppeak, Pplat , Raw, Cdyn) were monitored immediately before the incision (T1), OLV 60 min (T2), and OLV 120 min (T3). The blood gas analysis of the radial artery was collected at T2, and the OI, RI was calculated. VD/VT , Aa DO2; venous blood was collected at 120 minutes (OL) of OLV, serum concentrations IL-10, TNF-α, IL-6 were detected by EELISA; pulmonary complications occurred within 72 hours after operation. Results: Compared with group C, the serum concentrations TNF-α, IL-6, IL-10, Ppeak, Pplat , Raw, RI, VD/VT, A-aDO2 and pulmonary complications were lower in group P and PA. Cdyn and OI increased (P < 0.05). The serum concentrations IL-10, TNF-α, IL-6 in group A decreased, the incidence of RI, VD/VT, A-aDO2 and pulmonary complications decreased, and OI increased (P < 0.05); compared with group-P or group-A, the concentration of serum IL-10, TNF-α, IL-6 in the PA group, RI, VD/VT, A-aDO2 and pulmonary complications decreased, and OI increased (P < 0.05). Conclusion: Compared with the single application, penehyclidine hydrochloride combined with CPAP ventilation can improve lung function, inhibit inflammation and reduce lung injury in patients with COPD during thoracoscopic surgery, and help to improve prognosis.