Effect Of Extremity Ischemic Preconditioning On Expression Of Aquaporin 1 And Occludin In Lung Tissues Of Patients Undergoing Pulmonary Lobectomy

ObjectiveTo evaluate the effect of extremity ischemic preconditioning on the expression of aquaporin 1(AQP1)and occludin in the lung tissues and to investigate the effect the incidence of acute lung injury and length of postoperative hospital stay of patients undergoing pulmonary lobectomy.It can provide a new theoretical basis for clinical prevention and treatment in acute lung injury.MethodsForty-six American Society of Anesthesiologists physical status I or II patients,aged 30—64yr,weighing 50-80 kg,scheduled for elective pulmonary lobectomy performed via a thoracoscope.The exclusion criteria included cardiac disease categorized as New York Heart Association classes ? to ?,preoperative severe impairment of respiratory function(arterial oxygen tension[Pa02]<60 mmHg or forced expiratory volume in 1s<50%predicted),pre-existing coagulopathy or thrombocytopenia,previously received chemotherapy or radiation therapy or immunotherapy,systemic or local active infections(either clinically defined or suggested by evidence such as increased C-reactive protein levels,leukocytosis,or a body temperature of>38?),peripheral vascular disease affecting the upper limbs,and administration of vitamins,nonsteroidal anti-inflammatory agent,or corticosteroid within 3 months.These patients were randomly divided into 2 groups(n=23 each)using a random number table:control group(group C)and extremity ischemic preconditioning group(group R)After induction of anesthesia,the patients were intubated with the double lumen tube.Correct position of the tube was verified with the fiberoptic bronchoscope.In group R,ischemic preconditioning was induced by 3 cycles of 5-min lower extremity ischemia followed by 5-min reperfusion after induction of anesthesia.Lung tissues were obtained when the lobe of the lung was removed during surgery for determination of AQP 1 and Occludin expression(by Western blot)and wet/dry lung weight ratio and for microscopic examination of pathologic changes which were scored.Immediately after onset of one lung ventilation,at 30 and 60 rain of one-lumg ventilation,and at 1 h after restoration of two-lung ventilation,arierial blood samples were collected for blood gas analysis,and the oxygenation index was calculated.The development of postoperative complications and length of postoperative hospital stay were recorded.ResultsCompared with group C,the expression of AQP 1 was significantly up-regulated,and oxygenation index at 30 and 60 min of one lung ventilation and 1 h after restoration of two—lung ventilation were significantly increased,the pathologic score,the wet/dry lung weight ratio and incidence of postoperative pneumonia and atelectasis were significantly decreased,and the length of postoperative hospital stay was significantly shortened in group R(P<0.05).The expression of Occludin was no different between two groups(P>0.05).Conclusion(1)Extremity ischemic preconditioning can reduce lung injury through up-regulating AQP 1 expression in the patients undergoing pulmonary lobectomy.(2)The expression of Occludin was no different between two groups.