Effect Of PI3K/AKT/AP-1 Signal Pathway In Edaravone Influencing Cytokine On Patients After One-lung Ventilation

Objective:To investigate the effect of edaravone on inflammatory response after one lung ventilation in patients with esophageal cancer,and the effect of the phosphatidylinositol 3-kinase/protein kinase B/activated protein-1?PI3K/AKT/AP-1?signal pathway on molecular biology,and it will provide a new way of thinking and clinical basis for the prevention and alleviating the excessive inflammatory reaction with one-lung ventilation?OLV?during the clinical anesthesia.Methods:Sixty ASA I or II patients with esophageal cancer undergoing radical operation,aged35⁶8 year old and weighing 60⁸0kg with unlimited sex,without hypertension,coronar-y heart disease,neurological and psychiatric disease.All patients are selected at the Medical College of Qingdao University affiliated Qingdao Municipal Hospital in December 2016 to August 2017.All the patients underwent general anesthesia and were treated with double lumen tracheal intubation under fiberoptic bronchoscopy.Exclusion of preoperative patients under serious heart,brain,lung,liver and kidney dysfunction,endocrine related diseases,hypertension history of neurological and psychiatric disorders were excluded.Patients with past allergic history of Edaravone and patients with acute inflammatory diseases such as fever and infection before operation were excluded.All patients in this study were randomly divided into two groups:Edaravone group?EI group?and control group?CG group?.Anesthesia induction:Midazolam 0.03mg�kg^-1,fentanyl3?g�kg^-1,Cisatracurium 0.15mg�kg^-1 and 8%sevoflurane.Patients in edaravone group received edaravone 0.5mg�kg^-11 after induction of anesthesia,while those in control group were given the same volume of 0.9%NaCl.The two groups of patients have the same medication at the anesthesia maintenance stage.In order to balanced operation of the test results and consistent test conditions,all tests were performed by the same anesthesia with the same stage of treatment with anesthesiologists,the same surgery group of doctors and the same nurses of surgery.Among them,we excluded the fluctuation of MAP and HR in perioperative period,temperature<35.5?or>37.5,cardiopulmonary resuscitation,and bleeding were greater than those of 500ml or allogeneic blood transfusion in operation were also excluded.The central venous blood samples were obtained and detected at the following time points:T₀,T₁,T₂,T₃,T₄ and T₅ in the point of time before skin cutting and after anaesthesia,60 min after one lung ventilation,90 min after one lung ventilation,120min after one lung ventilation,30 min after bipulmonary ventilation,60 min post operation respectively.And bronchoalveolar lavage were performed through fiberoptic bronchoscopy and recovery of pulmonary bronchoalveolar lavage fluid?BALF?at the T₀ and T₃ points.The expression of PI3K,p-AKT,IL-8,TNF-?,MDA and SOD in blood samples and BALF were detected by ELISA test respectively.Results:?1?There was no significant difference between the two groups in the general data of sex,age,BMI and preoperative pulmonary function?P>0.05?;?2?There was no significant difference in operative time,single lung ventilation time,anesthesia time,PICU time,amount of bleeding,total infusion and urine volume.?3?Compared with T0,the expression of PI3K,p-AKT,AP-1,IL-8,TNF-?and MDA in blood samples and BALF were all significantly increased at T_1-5?P<0.05?in both two groups,and the expression of SOD is decreased at T_1-5?P<0.05?with central venous blood plasma and BALF with two groups.?4?Compared with CG group,the expression of PI3K,p-AKT and SOD in central venous blood plasma and BALF were all increased at T_1-5?P<0.05?,and the expression of AP-1,IL-8,TNF-?and MDA is decreased at T_1-5?P<0.05?with central venous blood plasma and BALF with all groups.Conclusion:?1?All patients with esophageal cancer have an inflammatory response after one-lung ventilation in this experiment.?2?Edaravone can inhibits the inflammatory response of the body during the one-lung ventilation in patients with esophagectomy.?3?P13K-AKT-AP-1 signaling pathway may be involved in the inflammatory response of the body with edaravone to inhibit the one-lung ventilation of the patients with esophageal cancer in this experiment.