Effect Of Sevoflurane Postconditioning On Lung Injury In Patients With One Lung Ventilation

BackgroundsOpen transthoracic esophagectomy is one of the standard surgical approaches for esophageal cancer.In order to provide a clear vision for the operation,one lung ventilation is needed,which leads to lung injury.Sevoflurane is a kind of inhaled anesthetic commonly used in clinic.It is safe,effective and easy to metabolize,what,s more,it has little effect on hemodynamics.Sevoflurane has a protective effect on many organs.The protective effect of sevoflurane postconditioning on lung has also been confirmed in animal experiments.ObjectivesTo study the effect of sevoflurane postconditioning on inflammatory stress and lung oxygenation in patients undergoing one lung ventilation for esophageal cancer radical operation,and to explore the effect of sevoflurane postconditioning on lung injury in patients with one lung ventilation,so as to provide theoretical basis for rational clinical medication.Methods60 patients undergoing elective one-lung ventilation?OLV?in esophageal cancer resection patients,aged 55 to 75 years old,ASA grade I-II,according to random number table method is divided into the control group?P group?and sevoflurane postconditioning group group?S?in the two groups,30 cases in each group.In group P,propofol and remifentanil were infused.At the end of OLV in group S,1.0 MAC sevoflurane was inhaled for 30 minutes for postconditioning.Propofol and remifentanil were infused intravenously until the end of operation.Before anesthesia induction?T₀?,30 minutes after the end of OLV?T₁?,4 hours after the end of OLV?T₂?,24 hours?T₃?after the end of OLV,the blood samples of radial artery were collected,and the concentrations of TNF-a,IL-8,SOD and MDA were measured by ELISA.Radial artery blood was collected at T₀,T₁,T₂ and T₃,and blood gas analysis was performed to record PaO₂ and PaCO₂,and the OI was calculated.ResultsComparison within the group:compared with T₀,IL-8,TNF-a and MDA in the two groups were significantly increased and SOD was significantly reduced at T₁,T₂and T₃,with statistically significant differences?P<0.05?.Comparison between groups:compared with the P group,IL-8,TNF-a and MDA in the S group at T₁,T₂and T₃ were significantly reduced,and SOD was significantly increased,with statistically significant differences?P<0.05?.Comparison within the group:compared with T₀,PaCO₂ in both groups was significantly increased at T₁,T₂ and T₃,and the difference was statistically significant?P<0.05?,while the difference between the two groups was not statistically significant?P>0.05?.Comparison between groups:compared with group P,PaO₂ in group S was significantly increased at T₁ and T₂?P<0.05?but insignificantly between the two groups at T₃?P>0.05?.Comparison within the group:compared with T₀,patients in the two groups had significantly lower OI at T₁,T₂and T₃,with statistically significant differences?P<0.05?.Comparison between the two groups:compared with the P group,patients in the S group had significantly higher OI at T₁ and T₂,with statistically significant differences?P<0.05?,but insignificantly between the two groups at T₃?P>0.05?.ConclusionsCompared with intravenous anesthesia,sevoflurane postconditioning is more beneficial to inhibit the production of inflammatory cytokines and maintain the balance of oxidation and antioxidation in patients with one lung ventilation;it is also better than general intravenous anesthesia in improving one lung ventilation and postoperative pulmonary oxygenation function,which has a certain protective effect on lung injury in patients with one lung ventilation.