Effect of remote ischemic preconditioning combined with dexmedetomidine on lung injury during one-lung ventilation in patients undergoing thoracic surgery
10.3760/cma.j.issn.1673-4904.2016.01.015
- VernacularTitle:开胸食管癌根治术患者单肺通气时经远程缺血预处理联合右美托咪啶对肺组织损伤的意义
- Author:
Chunxiang LI
;
Hong MA
- Publication Type:Journal Article
- Keywords:
Radical resection of esophageal carcinoma;
One-lung ventilation;
Ischemic preconditioning;
Dexmedetomidine
- From:
Chinese Journal of Postgraduates of Medicine
2016;(1):46-49
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the effect of remote ischemic preconditioning (RIPC) combined with dexmedetomidine on the lung injury during one-lung ventilation (OLV) in the patients undergoing thoracic surgery. Methods Eighty ASA physical status I or Ⅱ patients, scheduled for elective radical operation for esophageal cancer, were randomly divided into 2 groups(40 patients each group) using a random number table: control group and RIPC combined with dexmedetomidine group (ORD group). In ORD group,10 min after endotraeheal intubation, RIPC was induced by 3 cycles of 5 min lower extremity ischemia followed by 5 min reperfusion, and at the same time a loading dose of dexmedetomidine 1.0 μg/kg was infused intravenously over 15 min and then dexmedetomidine was infused at a rate of 0.5 μg/(kg·h) until the end of operation. At 0, 30 min, 1 h and 2 h of OLV(T1-4), blood samples were obtained from the radial artery for blood gas analysis and determination of plasma concentrations of tumor necrosis factor-α (TNF-α), interleukin (IL)-1βand IL-10.Oxygenation index and respiratory index were calculated. Exhaled breath condensate was collected at T1, T3 and T4, and the pH value was measured. Results The respiratory index at T2-4 in 2 groups were significantly higher than those at T1, control group: 1.16 ±0.12, 1.02 ±0.10 and 0.97±0.12 vs. 0.49±0.06, ORD group: 0.84±0.15, 0.72±0.12 and 0.65±0.10 vs. 0.48±0.08, there were statistical differences (P<0.05). The oxygenation index at T2-4 in 2 groups were significantly lower than those at T1, control group: (287.1±21.8), (306.8±35.2) and (312.9±25.5) mmHg (1 mmHg=0.133 kPa) vs. (426.5±39.0) mmHg, ORD group: (335.0±34.7), (341.1±41.3) and (359.1±38.8) mmHg vs. (433.6±23.8) mmHg, there were statistical differences (P<0.05). Compared with control group, the respiratory index at T2-4 in ORD group were elevated, the oxygenation index at T2-4 in ORD group were depressed, there were statistical differences (P<0.05). The TNF-α and IL-1β at T3-4 in 2 groups were significantly higher than those at T1, control group: (31.4±6.7) and (38.3±7.2) μg/L vs. (16.2±5.1) μg/L, (7.2±1.6) and (12.3±4.2) μg/L vs. (3.0±0.7) μg/L, ORD group: (21.7±5.4) and (23.4±5.1) μg/L vs. (16.3±4.7) μg/L, (4.8±0.9) and (6.3±1.6) μg/L vs. (2.9±0.8) μg/L, there were statistical differences (P<0.05). The pH value of exhaled breath condensate at T3-4 in 2 groups were significantly lower than those at T1, control group: 6.41±0.23 and 6.33±0.21 vs. 6.93±0.35, ORD group: 6.79±0.30 and 6.74±0.33 vs. 7.07±0.22, there were statistical differences (P<0.05). The IL-10 at T4 in 2 groups were significantly higher than those at T1, control group:(30.6±6.3) μg/L vs. (19.2±5.3) μg/L, ORD group: (41.3±5.2) μg/L vs. (19.5±4.9) μg/L, there were statistical differences (P<0.05). Compared with control group, the TNF-α and IL-1β at T3-4 in ORD group were depressed, the pH value of exhaled breath condensate at T3-4 in ORD group were elevated, the IL-10 at T4 in ORD group was elevated, there were statistical differences (P<0.05). Conclusions RIPC combined with dexmedetomidine can inhibit inflammatory responses and reduce airway acidification, thus attenuate the lung injury during OLV in the patients undergoing thoracic surgery.
