| Objective To observe the changes of serum interleukin-8 (IL-8),interleukin-10 (IL-10) and the expression of lung aquaporin 1 (AQP1) and aquaporin 4 (AQP4) in patients who need lung radical resection under one-lung ventilation and the effects of clinical intervention by Ulinastatin, and provide a new theoretical basis in lung protection for surgical patients undergoing one-lung ventilation.Methods 30 lung cancer patients need radical surgery, ASAâ… orâ…¡, aged 38-70 years, weight 48-78kg, Male 21, female 9. All patients are no preoperative chemotherapy and radiotherapy, no obvious lung infection, no immune system disorders before surgery, and oxygenation 90% or more when intraoperative one-lung ventilation.All patients were randomly divided into three groups(n=10):control group (groupâ… ), Ulinastatin 5000U group (groupâ…¡), Ulinastatin 10000U group (groupâ…¢). The use of narcotic and anaesthesia were identical in operation. Groupsâ…¡,â…¢in which patients received Ulinastatin 5000U/kg,10000 U/kg which was diluted to 20ml with normal saline.When the first piece of normal lung tissue was cut, We started to pump Ulinastatin immediately in 10 min. Groupâ… pump 20ml normal Saline.When lung Lobe was resected,the second piece of lung tissue obtained from it immediately.All patients were measured serum IL-8, IL-10 levels at 6 time points which were intubation (T1), one-lung ventilation 30min (T2),one-lung ventilation 60min (T3), one-lung ventilation 90min (T4),one-lung ventilation 120min (T5), two lung ventilation 30min (T6), and the expression of AQP1,4 and pathological features of the first and the second lung tissue were measured.Results IL-8 changes:As compared with T1, there are no significant changes in 3 groups at T2, and the level of IL-8 in 3 groups were significantly higher at T3-T6 (P <0.05 or P<0.01)), especially in groupâ… (P<0.01). Compared with groupâ… , groupâ…¡and groupâ…¢were different at T3(P<0.05), groupâ…¡andâ… are different at T4 (P <0.05),groupâ…¢were different significantly with groupâ… and groupâ…¡at T4,T5 (P <0.01); IL-10 changes:As compared with T1, T2-T6 were was significantly higher in the 3 groups (P<0.01), especially in groupâ…¢. Compared with groupâ… , groupâ…¡andâ…¢were significantly higher at T2(P<0.01); groupâ…¡,â…¢were higher at T3-T5(P <0.05), especially in groupâ…¢(P<0.01); The comparison between groupâ…¡and groupâ…¢were different at T4, T5 (P<0.05), especially at T4 (P<0.01). AQP1 changes:The expression of AQP1 in 3 groups were not significantly different in first piece of lung tissue (P> 0.05); Compared with the first piece of lung tissue, The AQP1 expression of groupâ… andâ…¡were significantly decreased in the second piece of lung tissure (P<0.05), especially in groupâ… ,and there was no significantly in groupâ…¢. Compared with groupâ… , groupâ…¡andâ…¢were significantly different (P <0.05); AQP4 changes:There were no significant difference of AQP4 expression in the first piece of lung tissue in 3 groups (P> 0.05); Compared with the first piece of lung tissue,the expression of AQP4 in the second piece of lung tissue were significantly lower in groupâ… (P<0.05),and groupâ…¡>â…¢were significantly higher than groupâ… in the second piece of lung tissure (P<0.05). HE staining of lung tissue pathological features:the first piece of lung tissue were normal in 3 groups, the structures of the second lung tissue were seriousl damaged in groupâ… :a large number of alveolar exudation and hemorrhage,pulmonary interstitial infiltration with inflammatory cells, alveolar wall thickening, interstitial edema. Alveolar cavity exudates and bleeding, pulmonary interstitial inflammatory cells infiltration, alveolar wall thickening and edema in groupâ…¡but not as severe as in groupâ… ; Lung tissue structures are more clearly groupâ…¢,and pathological changes in lung tissue are less than groupâ… andâ…¡.Conclusion (1) IL-8, IL-10, AQP1, AQP4 are involved lung injury of one-lung ventilation; (2) Ulinastatin can reduce the level of serum IL-8 and increase IL-10,AQP1 and AQP4 expression,and can alleviate the pathological changes caused by one-lung ventilation; (3) Ulinastatiri can reduce the injury induced by one lung ventilation, and the effect was dose-dependent. |
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