Effects Of Different Preconditioning Methods On Intraoperative SP-A And Postoperative Outcome In Patients Undergoing Single Lobectomy

Background&ObjectiveWith the widespread popularization and application of minimally invasive techniques in clinical work,thoracoscopic assisted lobectomy has become an important means of thoracic surgery for lung cancer.Compared with conventional thoracotomy,thoracoscopic assisted lobectomy has unparalleled advantages,but it is not perfect.Thoracoscope-assisted lobectomy is still limited in the treatment process.For example,incision implantation may occur,which is mainly due to the metastatic and enlarged lymph nodes for tumor lesions in the course of surgery,the capsule of the enlarged lymph nodes is very prone to rupture.Iatrogenic transmission and incision implantation will occur once the capsule ruptures,and due to uncontrollable bleeding,disturbance of the lymph nodes,and the larger tumor of the patient,which often needs to turn to open the chest.In the thoracic surgery,especially in TV-assisted thoracoscopic surgery,the use of one lung ventilation（OLV）has become an indispensable technique in the thoracoscope-assisted lobectomy,and the use of OLV will undoubtedly cause a relative reduction in the operative field.Therefore,surgical instruments are often needed to replace the fine manual operation in clinical practice,so if we want to finish a thoracoscopic lobectomy with quality and quantity,the operative time needed for thoracotomy will be longer than that of traditional thoracotomy,the time of OLV will also extend.A large number of domestic and foreign reports have been reported and confirmed that OLV will cause varying degrees of damage to the ventilated and collapsed lungs.The longer the OLV time in the operation,the higher the incidence of acute respiratory failure,arrhythmia,and pulmonary hypertension after operation,concluded that>1 h of OLV is a potential cause of respiratory and circulatory complications.In addition,lung injury caused by OLV will cause secondary hazards to patients who have had mild or moderate pulmonary function before surgery.Severe patients eventually develop acute lung injury（ALI）,which will seriously affect perioperative safety and postoperative recovery of patients with the thoracic surgery.In recent years,a number of experimental studies have shown that sevoflurane and edaravone can exert protective effects on lung injury caused by OLV through various mechanisms.Therefore,the purpose of this study is to use sevoflurane pretreatment,edaravone pretreatment,and sevoflurane combined edaravone pretreatment in lung cancer patients undergoing thoracoscopic lobectomy,and then combine the analysis and discussion of the intraoperative index of lung injury and postoperative recovery,and hope that three pretreatments can be better to reduce the lung injury caused by OLV during the operation,then reduce postoperative chest drainage as much as possible,and prompt the recovery of lung function in patients.So that the thoracic drainage tube can be removed as soon as possible,shortening the postoperative tube time and the postoperative hospitalization days,and finally reducing the patient’s hospital economic burden.Materials&MethodsSelect 80 patients with lung cancer undergoing thoracoscopic lobectomy of the Gansu Provincial Hospital from February 2017 to October 2017,of which 54 were male,26 were female,age 40-65 years,were randomly divided into four groups,20cases in each group,four groups were as follows:（1）control group（Group C）;（2）Sevoflurane pretreatment group（Group S）;（3）Edaravone pretreatment group（Group E）;（4）Sevoflurane combined edaravone pretreatment group（Group S+E）.Group C:100m L physiological saline was administered before OLV after induction of anesthesia;Group S:sevoflurane was inhaled for 30 min before OLV after induction of anesthesia.An inhaled concentration of sevoflurane was monitored to maintain a minimum alveolar concentration（MAC）of 1.0;Group E:edaravone was given at 1mg/kg in equal amount of saline within 30 min before OLV after induction of anesthesia;Group S+E:edaravone was given at 1mg/kg while sevoflurane was inhaled in equal amount of saline within 30 min before OLV after induction of anesthesia.The blood samples of the cubital veins were collected in the four groups at 30 min after two lung ventilation（T₁）,OLV 30 min（T₂）,OLV 1h（T₃）,recovery of 30 min after two lung ventilation（T₄）and 1h after operation（T₅）.The serum concentration of surfactant protein A（SP-A）in the serum of cubital venous blood was measured by ELISA and the operation time and OLV time were recorded.Postoperatively,all of the patients were sent to the post-anesthesia care unit（PACU）,and patients were admitted to the ward after reaching the discharge standard.At the same time,follow-ups were performed on the four groups of patients.The datas of the postoperative tube time and postoperative hospitalization days were collected in each group of patients.The designated nurses recorded the postoperative chest drainage volume on the 1st,2nd,and 3rd day and the total amount of postoperative chest drainage.The time of extubation was calculated by the attending physician.After12:00 am,the extubation time was increased by 0.5 days.Results（1）Basic data comparison among the four groups:there was no significant difference in age,gender composition,weight,height,body mass index,FEV₁,FEV₁/FVC,MVV,MVV%,OLV time,operative time and tumor site among four groups（P>0.05）.（2）Comparison of serum SP-A concentrations:After OLV,the serum levels of SP-A in the four groups were increased,the difference was statistically significant（P<0.05）;after recovery of two lung ventilation,the serum SP-A levels in group C continued to increase compared with T₃,while the three pretreatment groups all decreased,and the difference was statistically significant（P<0.05）.There was no statistically significant difference at T₁ among the four groups（P=0.571>0.05）.There was a statistically significant difference between S group and S+E group（P<0.05）.There was no significant difference among the other groups（P>0.05）.（3）Comparison of postoperative indexes:The postoperative chest drainage volume on the 1st,2nd,and 3rd day and the total amount of postoperative chest drainage and the postoperative tube time and the postoperative hospitalization days of the three pretreatment groups were all less than those of the group C,and the difference was statistically significant（P<0.05）;Compared with S+E group,the postoperative chest drainage volume on the 1st,2nd,and 3rd day in S group was higher than S+E group,the difference was statistically significant（P<0.05）.Compared with S+E group,the postoperative tube time and the postoperative hospitalization days in S group were longer than those in the S+E group,the difference was statistically significant（P<0.05）.There was no statistical difference among the other groups.ConclusionsThe three pretreatments have lung protective effects on thoracoscopic lungcancer patients undergoing single lobectomy,and sevoflurane combined with edaravone pretreatment has more significant lung protection than sevoflurane pretreatment alone.