The Protective Effect Of Alprostadil To Induced Ventilation Function Injury By Smoking Patients After Lobectomy Of Lung

Objective: To explore the protective effect of alprostadil to induced ventilation function injury by smoking patients after lobectomy of lung.Methods: 45 patients(American Society of Anesthesiologists class 2 or 3) scheduled for elective lobectomy of lung under general anesthesia, The 15 patients was a control group without smoking history,the other patients totally 30 who smoked for more than 10 years and smoking cessation over 2 weeks before surgery.The smoking patients were randomly assigned to two groups for each 15 patients,one is groupY,the other is experimental group of named group Z. Group K as a control group in 15 patients that no smoking history. In experimental group, 5 ug alprostadil diluted to 10 ml in physiological saline was injected with intravenous injection pump 15 minutes before anesthesia induction and after operation, respectively,(within 30 minutes); The other two groups use same capacity normal saline instead. Insert the bronchial lumen after anesthesia induction and fiberoptic bronchoscopy determine its location and position. Pure oxygen mechanical ventilation after a successful intubation, using protective lung ventilation during operation, as low VT as 6ml/kg×PBW. Set RR 14 times/min, FIO2 0. 5%, PEEP is set to 5 cm H2 O, absorption ratio of 1:2. Then adjust breathing rate to maintain a breath at the end of the CO2 partial pressure(PCO2) in 4. 6 ~ 5. 4 kPa(35 ~ 40 mmHg). According to the intraoperative circulation parameters adjusted intravenous anesthetics dose makes the BIS value between 40 to 60.Record FiO2, PaO2 / FiO2, PCO2, airway pressure, peak pressure, and pulmonary compliance before anesthesia(T0), patients with general anesthesia intubation(T1), single lung ventilation for 30 minutes(T2), single lung ventilation for 60 minutes(T3), double lung ventilation after surgery(T4), 1 hour after surgery(T5), 24 hours after surgery(T6). Determination of serum markers before anesthesia(T1), after surgery(T2), the first day after surgery(T3), extract venous blood 4 ml, take 1 ml supernate after centrifuge, refrigerate in- 80℃ refrigerator until interleukin 8, interleukin 10, tumor necrosis factor α, and creactive protein be detected.Results: There was no significant difference in the three groups about basic information statistical comparison(P>0. 05). There are 2 cases in group K,3 cases in group Y,and 2 cases in group Z were excluded from the study,because of the visual analogue scale(VAS) is more than 6. The Respiratory index(RI) in three groups all decreased significantly after endotracheal intubation was statistically significant(P<0.05), meanwhile,the respiratory index(RI)in three groups had statistically significance in 1 hours after surgery(P<0.05);And oxygen index(OI) after endotracheal intubation in three groups were significantly elevated( P<0.05), meanwhile, the oxygen index(OI) was obviously increased in 1 hour after surgery and the first day after surgery was statistically significant(P<0.05);The content of serum markers IL-8 in serum of three groups were significantly higher(P<0.05) after the surgery began, Compared with the groupZ and group K at the end of the operation, the IL-8 levels in groupZ is significantly reduced than groupY that was statistically significant(P<0.05);TNF-α content in the three groups were significantly increased after the surgery began was statistically significant(P<0.05),.Compared with the other two groups at the end of the surgery and the first day after surgery, in group Z the TNF-α content decreased significantly, was statistically significant(P<0.05);IL-10 content in the three groups were significantly increased after the surgery began was statistically significant(P<0.05), Compared with the group Y at the end of the surgery, the IL-10 content in goup Z and group K increased significantly, was statistically significant(P<0.05); Compared with the other two groups at the first day after surgery, the IL-10 content in goup Z increased significantly, was statistically significant(P<0.05); CRP in the three groups did not change significantly preoperatively at the end of the operation and no statistical significance(P>0. 05), On the first day in the three groups were significantly increased(P<0.05), but is no statistical difference between two groups(P>0. 05).Conclusion: alprostadil can improve pulmonary ventilation function and oxygenation capacity in patients who smokes after lobectomy of lung, and can reduce the generation of inflammatory factor such as TNF-α, IL-8 and can improve the production of protective inflammation factor IL-10. In all, alprostadil has a certain positive role in the protection of lung function.