| Objective To observe the influence of hypertonic-hyperoncotic solution (HHS) on the changes in hemodynamic,arterial blood gas analysis,the expression of lung aquaporin-1(AQP1) and aquaporin-4(AQP4) and lung tissue pathology morphology in patients who need lobe lung radical resection under one-lung ventilation (OLV). to investigate the lung protective effects of HHS and provide certain theoretical basis for perioperative liquid management for thoracotomy patients undergoing OLV.Methods Lung cancer patients need lobe radical surgery.60cases.ASAâ… orâ…¡.aged 41-69 years.weight 48-72kg, male 35.female 25.All patients were randomly divided into three groups (n=20):group I (conventional infusion group), groupâ…¡(restrictive infusion group), group III(restrictive infusion HSH40 group).The use of narcotic and anaesthesia were identical in operation. When thoracic cavity opened, the first piece of normal lung tissue was cut in the determining resected lobe at which was away from tumor tissue.The second piece of lung tissue was obtained from the same place when lung lobe was resected immediately.Group I and II in which patients received 10 and 5ml/kg/h liquid infusion respectively.Electrolyte solution A and hydroxylethyl starch 130/0.4 solution (HES) were infused with 1:2 in volume. Groupâ…¢in which patients received the same infusion way as patients in groupâ…¡.but 5ml/kg hypertonic-hyperoncotic solution 40(HSH40) have replaced equal volume of HES when the first piece of normal lung tissue was cut, and the shortage of colloid was replenished with HES.All patients were measured hemodynamic and arterial blood gas analysis at 6 time points which were before intubation(To).after intubation (T1).two lung ventilation(TLV)30min(T2),OLV 30min(T3),postoperation 30min (T4).after extubation(T5).Three groups of patients were measured the expression of AQP1,4 and observed the change of the pathological morphology of the first and second lung tissue.Results There were not statistically significant difference in the general data of patients between groups(P>0.05). Heart rate changes:as compared with To, T1-4 3 groups were significantly higher(P<0.05),T5 in groupâ…¡were significantly higher (P<0.05):as compared with T1,T2 in groupâ… andâ…¢were significantly higher (p<0.05), T4-5 were significantly lower(P<0.05).T2-4 in groupâ…¡were significantly higher(P<0.05);compared with groupâ… ,groupâ…¡were increased on T2-5(p<0.05), groupâ…¢were increased on T3(p<0.05); compared with groupâ…¡, groupâ…¢were decreased on T3-5(P<0.05).Mean arterial changes:as compared with To, T1-3 3 groups were significantly decreased(P<0.05),T4-5 in groupâ…¡were significantly decreased (p<0.05), the biggest decline was about 30 percent of T0,T5 in groupâ… andâ…¢were significantly increased(P<0.05), the biggest rise was about 15 percent of T0,as compared with T1,T2-5 3 groups were significantly increased(P<0.05),especially in groupâ… andâ…¢;compared with groupâ…¡the difference was evident(P<0.05). Cardiac output(CO) and stroke volume(SV) changes:there were not statistically significant difference between groups on T1(P>0.05).as compared with T1,T2-4 in groupâ… were significantly increased(P<0.05),T3-4 in groupâ…¡and III were significantly increased(P<0.05),especially in groupâ… andâ…¢;compared with groupâ… andâ…¢,groupâ…¡were different(P<0.05).Stroke volume variation(SVV) changes: there were not statistically significant difference between groups on T1 (P>0.05),as compared with T1,T2-4 in groupâ… were significantly decreased(P<0.05),T3-4 in groupâ…¡andâ…¢were significantly decreased(P<0.05);compared with groupâ… groupâ…¡were increased at T4-5(P<0.05),groupâ…¢were increased at T2 (p<0.05).compared with groupâ…¡.groupâ…¢were decreased at T3-4 (p<0.05).Compared with group I and III,the dosage of intraoperative vascular active drug in groupâ…¡were significantly increased(P<0.05).the volume of intraoperative urine output were significantly decreased(p<0.05);compared with groupâ… .the volume of intraoperative infusion in groupâ…¡were significantly decreased (p<0.05).Arterial blood gas analysis:as compared with T2,PaO2 in 3 groups were significantly decreased on T3-4(p<0.05), oxygenation index(OI) in 3 groups were significantly decreased on T3(p<0.05).SB changes:as compared with T0,group ll were significantly decreased on T5(p<0.05),as compared with T1,groupâ…¡were significantly decreased on T4(p<0.05).Lac changes:as compared with T0,groupâ…¡were significantly increased on T5(p<0.05);as compared with T2,groupâ…¡were significantly increased on T4(p<0.05);the comparison between groupâ… and group ll were different at T4,T5(p<0.05),there were not statistically significant difference between groupâ…¡and groupâ…¢,but there had a rise trend in groupâ…¡.AQP1 and AQP4 changes:compared with the first piece of lung tissue,groupâ… andâ…¡were significantly decreased in the second piece of lung tissue (p<0.05).compared with groupâ… and . groupâ…¢were significantly different (p<0.05).HE staining of lung tissue pathological features:the first piece of lung tissue were normal in 3 groups.The second lung tissue were damaged on certain degree:part of the alveolar collapse.the alveolar space exudation.hemorrhage and inflammatory cells infiltrating.alveolar wall thickening,pulmonary interstitial edema.but the degree of the damage was more severe in groupâ… andâ…¡.less severe in groupâ…¢.Conclusion (1) Neither conventional nor restrictive infusion can avoid OLV induced acute lung injury(ALI),especially in conventional infusion;(2)HSH40 can up regulate the expression of AQP1,4 in lung.and obviously relieve the change of the lung tissue pathology morphology induced by OLV;(3)The administration of HSH40 in restrictive infusion has certain lung protective effects for in patients undergoing thoracotomy intraoperative OLV.
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