| Objectives:The effect of remote ischemic preconditioning(RIPC)in patients undergoing single lung ventilation and open-chest lobectomy with oxygenation index(PaO2/FiO2),oxidative stress(MDA levels),inflammatory cytokines(IL-6,TNF-a,IL-10)and postoperative pulmonary complications and postoperative hospital stay time,to evaluate the protective effects of distal ischemic preconditioning.Methods:Selected from the Third Affiliated Hospital of Kunming Medical University from March 2017 to November 2017 to be scheduled for open-chest lobectomy in 57 patients with stage I-II non-small cell lung cancer,aged 31-71 years,weight 48-90 kg,ASA grade Grade I-II,preoperative lung function indicators normal or only mild pulmonary dysfunction.The random number table was used to divide into control group(C group,n=29)and remote ischemic preconditioning group(R group,n=28).After induction of anesthesia and intubation of the left double-lumen endotracheal tube was completed,the two groups had a tourniquet 1-2cm above the right lower extremity armpit and the tourniquet inflation pressure in the R group was 200mmHg.The pressure was reduced to zero after 5 minutes of blood flow blocking.The blood flow was resumed for 5 min and repeated 3 times;the tourniquet in the right lower extremity of group C was kept at zero pressure,and the two groups were removed from the tourniquet and completed the follow-up study after completion of RIPC.Before induction of anesthesia(Ti),15min after ventilation of one lung(T2),15min after recovery of ventilation of both lungs(T3),60min after recovery of ventilation of both lungs(T4),60min(Ts)after removal of double lumen tracheal intubation at one time,1 ml of arterial blood sample was taken for blood gas analysis and oxygenation index was calculated.The MDA,IL-6,TNF-a and IL-10 levels were measured in 6 ml venous blood samples,and postoperative related pulmonary complications and postoperative hospital stay were recorded.Re ults:There was no significant difference in age,weight,sex ratio,ASA grade,surgical type,infusion volume,blood loss,urine volume,operation time,anesthesia time,single lung ventilation time,PaCO2,and HCT between the two groups(P>0.05).Oxygenation index:Compared with Ti,when T2,T3,T4,and T5 in group C,T2 and T3 in group R were significantly decreased(P<0.05),and the oxygenation index of the two groups was lowest at OLV 15 min(T2).While R group T4,T5 significantly increased when the le’vel close to Ti,compared with Ti no significant difference(P>0.05).Compared with the time points of T2,T3,T4,and T5 in both groups,the reduction level in group R was significantly smaller than that in group C(P<0.05).MDA levels:Compared with T1,when T2,T3,T4,and T5 in group C,T3 and T4 in group R increased significantly(P<0.05).The MDA in two groups rose to the highest level in T3,while there was no in group T2.Significant changes(P>0.05)began to gradually decrease until T4,and Ts significantly fell back to levels close to Ti(P>0.05).Compared with the time points of T2,T3,T4 and T5 in both groups,the level of MDA in R group was significantly lower than that in C group(P<0.05).Levels of IL-6 and TNF-a:Compared with T1,IL-6 and TNF-a were significantly increased in the two groups at T2,T3,T4,and T5(P<0.05),and T3,T4,and Ts in both groups.Compared with the control group,the levels of IL-6 and TNF-a in the R group were significantly lower than those in the C group(P<0.05).Compared with the Ti,the IL-10 levels in the two groups at T2,T3,T4,and T5 were significantly increased(P<0.05),C group rose to 43.97 ± 4.21 pg/ml at T5,while R group increased to the highest 45.41 ± 5.23 pg/ml at T5.Compared with the time points of T3,T4,and T5,the levels of IL-10 in the R group were significantly higher than those in the C group(P<0.05).The incidence of postoperative pneumonia and atelectasis was significantly lower in group R than in group C(P<0.05).There was no significant difference in the incidence of postoperative ALI and ARDS(P>0.05).Conclusions:1.Remote ischemic preconditioning can improve the oxygenation index,reduce the levels of MDA,IL-6 and TNF-a in patients with single-lung ventilation and thoracotomy,and promote the production of anti-inflammatory cytokines IL-10,and reduce the lungs damage.2.Remote ischemic preconditioning can reduce postoperative complications and shorten hospital stay.3.Remote ischemic preconditioning may play a role in the protection of lung tissue through anti-inflammatory and anti-oxidative stress. |
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