The effects of lung protective ventilation strategy on perioperative lung compliance and oxygenation function in patients undergoing gynecological open surgery in plateau area

Zhang Peifu; Xiong Chenglong; Duo Haizhen; Jun Lin; Wang Xuejun

doi:10.3760/j.issn.1673-4777.2025.07.007

Abstract：Objective To investigate the effects of lung protective ventilation strategy on perioperative lung compliance and oxygenation function in patients undergoing gynecological open surgery in plateau area.Methods Sixty patients who underwent gynecological open surgery in Qinghai Red Cross Hospital in the plateau region from December 2023 to December 2024 were selected.According to the random number table method,they were divided into conventional ventilation group(group C)and lung protective ventilation group(group L),with 30 cases in each group.In group C,the tidal volume was 10 ml/kg,and there was no positive end-expiratory pressure and lung recruitment maneuverduring the operation.In group L,the tidal volume was 6-8 ml/kg,positive end-expiratory pressure was 5 cmH2O,and lung recruitment maneuvers were performed every 30 minutes.The peak airway pressure,mean airway pressure,lung compliance and vital signs were compared between the two groups at 5 min after anesthesia induction intubation(T1),1 h after mechanical ventilation(T2)and before surgical extubation(T3).Arterial blood samples were collected at each time point for blood gas analysis.Arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),alveolo-arterial partial pressure of oxygen(PA-aDO2),oxygenation index and the ratio of dead space to tidal volume were compared.Results The levels of the end-tidal carbon dioxide partial pressure at T2 and T3 in group L were significantly higher than those in group C(both P＜0.05).The peak airway pressure and mean airway pressure at T2 and T3 in group L were significantly lower than those in group C,and the lung compliance was significantly higher than that in group C[(56±16)L/cmH2O vs(47±9)L/cmH2O,(56±16)L/cmH2O vs(46±9)L/cmH2O](all P＜0.05).Compared with T,,PaO2 and oxygenation index at T2 and T3 were significantly decreased in the two groups,PA-aDO2 and the ratio of ineffective cavity to tidal volume increased significantly,PaCO2 decreased significantly at T2 and T3 in group C,and PaCO2 increased significantly at T2 and T3 in group L(all P＜0.05).PaO2,PaCO2 and oxygenation index at T2 and T3 in group L were significantly higher than those in group C,while PA-aDO2 was significantly lower than that in group C(all P＜0.05).Conclusion Lung protective ventilation strategy can significantly improve perioperative lung compliance and oxygenation function in patients undergoing gynecological open surgery in plateau area,and reduce the incidence of postoperative pulmonary complications.