The Protective Effect Of Phosphocreatine Pretreatment On Ischemia Reperfusion Injury After Single Lung Ventilation

Objective:Video assisted thoracoscopic surgery(VATS)patients often need to use one lung ventilation for respiratory management,acute lung injury after operation is one of the serious complications in the Department of thoracic surgery,one lung ventilation induced lung ischemia reperfusion injury is considered as an important factor in its pathogenesis.In recent years,the study found that phosphocreatine can reduce some important organs ischemia reperfusion injury,has a protective effect,but for lung ischemia reperfusion injury after single lung ventilation has a protective effect that has not been reported.This study intends to observe if phosphocreatine pretreatment on single lung ventilation patients underwent thoracoscopic surgery has the lung protective effect,and explore its mechanism of action.Method:choose 40 patients who will undergo thoracoscopic lobectomy with anesthesia for single lung ventilation as the research objects,age:18 years old to 65 years old,ASA grade:I to II,expected one lung ventilation between 60min and 120min.ASA classification:III to IV,respiratory function obstacle,coagulopathy or thrombocytopenia,chemotherapy or radiotherapy or immunotherapy,local or systemic infection,within 3 months of taking vitamins or non steroidal anti-inflammatory drugs or corticosteroids patients should be excluded.all patients were randomly divided into control group and experimental group by digital table.Patients in the control group(20 cases):preoperative,intravenous infusion of saline 100ml0.9%,infusion time of 30 minutes.Patients in the experimental group(20 cases):30 minutes before operation,30mg/kg of sodium phosphocreatine into normal saline 100m10.9%intravenous infusion time 30min.All patients should be given routine preoperative preparation,received phenobarbital atropine 0.1g,0.5mg in ward half an hour before entering the operation room.Inhale low flow oxygen with mask,establish of dynamic and venous access after went into the operation room.Monitor heart rate,blood oxygen saturation,invasive arterial blood pressure,BIS and other basic vital signs.Inject midazolam 0.1mg/kg,sufentani 10,5-1ug/kg,cisatracurium 0.15-0.2mg/kg,etomidate 0.3mg/kg for induction of anesthesia,use video laryngoscope for double lumen endotracheal intubation,bronchoscopic positioning,non operative side single lung ventilation was used after operation.Continuous infuse propofol,remifentanil and cisatracurium to maintain the depth of anesthesia,and adjusting according to the BIS value,add sufentanil continuously,maintaining BIS value 40-60,keep hemodynamic fluctuation range is less than 20%compare with entering the operation room.Collect 3.5ml blood into the 5ml coagulation test tube at the time of one lung ventilation immediately(TO),1h after one lung ventilation(T1),1h after two lung ventilation(T2),2h after two lung ventilation(T3)through radial artery,the sample solidified at room temperature,the supernatant was collected after centrifugation.The specimens were stored in the-80 low temperature freezer,and all samples were collected and tested together.ELISA was used to detect IL-6 and TNF-at different time points.MPO was detected by colorimetric method and MDA was detected by thiobarbituric acid method.Results:two groups of single lung ventilation serum inflammatory factor TNF-alpha,IL-6 and oxidative stress indexes of MPO,MDA as time increased in different degree,but after the pretreatment of phosphocreatine in experimental group serum IL-6 level,MDA level and MPO activity inTl,T2,T3 time points and serum TNF-levels in T2,T3 time point compared with the control group decreased significantly(P<0.05).Conclusion:1.There was an increase of inflammatory factor TNF-alpha,IL-6 and oxidative stress index MPO and MDA in the process of single lung ventilation,suggesting that the single lung ventilation can cause lung injury.2.Creatine phosphate pretreatment can reduce the increased of inflammatory factor TNF-alpha,IL-6 and oxidative stress indexes of MPO,MDA,and had protective effects on lung injury after one lung ventilation,its mechanism may be that reduced inflammation reaction and oxidative stress caused by ischemia reperfusion after one lung ventilation.