To investigate the clinical application of volume-controlled ventilation (VCV), pressure-controlled ventilation (PCV), and pressure-controlled volume-guaranteed ventilation (PCV-VG), and to observe the intraoperative hemodynamics, respiratory mechanics, blood gas indexes and postoperative complications of patients with liver cancer complicated with portal hypertension undergoing laparoscopic hepatectomy.

120 patients with liver cancer complicated with portal hypertension who underwent laparoscopic hepatectomy from January 2017 to June 2019 were prospectively selected as the research subjects. The patients were divided into VCV group, PCV group and PCV-VG group by random number table method, with 40 cases in each group. Statistical analysis were performed by using SPSS 20.0 software. Measurement data, such as perioperative indicators and heart rate at each time point [10 min before pneumoperitoneum after intubation (T0) , 30 min after pneumoperitoneum (T1), 1 h after pneumoperitoneum (T2), 10 min after pneumoperitoneum (T3)] were expressed as (±s), and were examined by using repeated variance analysis. Postoperative complications were analyzed by using χ² test A P value< 0.05 was arterial oxygen partial considered as statistically significant difference.

Compared with T0, intraoperative mean arterial pressure (MAP), airway mean pressure (Pmean), airway peak pressure (Ppeak), pressure (PaO₂), respiratory partial carbon dioxide partial pressure (PETCO₂), and arterial partial carbon dioxide partial pressure (PaCO₂) in the three groups were significantly increased during T1~T2 (P<0.05), while dynamic lung compliance (Cdyn) was significantly decreased (P<0.05). Ppeak in PCV-VG group was lower than those in VCV group and PCV group during T1~T2 (P<0.05), and Pmean of PCV-VG group was lower than those in VCV group during T1~T3 (P<0.05). Both the PCV-VG group and the PCV group had higher Cdyn than the VCV group at T1~T2 (P<0.05), and the PCV-VG group had higher Cdyn than the PCV group at T2 (P<0.05). The total incidence of complications in PCV-VG group and PCV group was significantly lower than that of VCV group on POD 7 (P<0.05); The incidence of atelectasis in PCV-VG group was significantly lower than that in VCV group (P<0.05).

For patients with liver cancer and portal hypertension undergoing laparoscopic hepatectomy, the PCV-VG model could reduce airway pressure, improve lung compliance, and to decrease the incidence of postoperative pulmonary related complications with higher safety.