Effect Of Dexmedetomidine Combined With Propofol Or Sevoflurane Anesthesia On Infammatory Factor In Patients With One-lung Ventilation

Objective:One-lung ventilation(OLV)is widely used in various thoracic surgery.However,physiological abnormalities caused by one-lung ventilation are likely to cause lung injury.For example:ventilation-blood flow mismatch and early hypoxia can exacerbate the inflammatory response.As a new type of ?2 adrenergic receptor agonist,dexmedetomidine(Dex)participates in anti-inflammatory and reducing ischemia-reperfusion injury,which has been confirmed in animal experiments or clinical experiments.Propofol and sevoflurane both have anti-inflammatory and inhibiting oxidative stress effects,but there is no consensus on which one has stronger lung protective effect under one-lung ventilation.DEX combined with propofol and sevoflurane anesthesia are two kinds of anesthesia programs commonly used by clinical anesthesiologists.The purpose of this study was to discuss the effect of two anesthesia programs on inflammatory factors in patients in one lung ventilation state.Methods:Twenty-eight patients who underwent elective thoracoscopic lobectomy were divided into two groups by computerized random number table:The propofol group(P)and the sevoflurane group(S),14 patients each group.The two groups of patients were routinely abstained from drinking and fasting before surgery.BP,HR,SPO2 and ECG after entering the operating room.After the peripheral venous access to the upper limbs was opened,both groups were Intravenous pumping of dexmedetomidine 0.7ug/kg-1·h-1 for 10min,and then maintained at 0.4ug/kg-1·h-1.Radial artery puncture manometry under local anesthesia monitors invasive arterial blood pressure.Induction of anesthesia:propofol 2 mg/kg iv,fentanyl 3?g/kg iv,vecuronide 0.1 mg/kg iv.After anesthesia induction,a double-lumen bronchial tube was placed orally and positioned with a fiberoptic bronchoscope until the tube was positioned correctly,connect an anesthetic machine to control breathing.All adopt IPPV mode for positive pressure ventilation,ventilation parameter settings were set as follows:Tidal volume 8-10ml/kg,ventilation frequency 10-14 times/minute,respiration ratio 1:2,oxygen flow 2L/min;maintaining peak lung airway pressure?20mmHg,intraoperative single airway pressure?30mmHg,End-expiratory carbon dioxide 30-40mmHg.Intraoperative maintenance medication:Group P was continuously pumped with propofol 4-8 mg/kg-1·h-1;Group S was administered with 1%to 3%sevoflurane inhalation anesthetic;both groups received remifentanil 0.2ug/kg-1·h-1 continued analgesia during the operation.Intermittent injection of vecuronide to maintain satisfactory muscle relaxation.Right jugular central venous catheterization after endottacheal intubation in both groups.The same perioperative fluid regimen was used in both groups:supplemented cumulative losses,amount of physiological demand,intraoperative blood losses and the third space losses;cumulative losses=amount of physiological demand × fasting time;amount of physiological demand:the first 10kg infusion dose is 4ml/kg,the second 10kg infusion dose plus 2ml/kg,20kg or more per kg infusion dose plus 1ml/kg.Half of the amount is replenished in the first hour,and the remaining liquid was infused at followed 2 hours.The third space losses is infused by 4ml·kg-1·h-1.Intraoperative infusion was comprised with electrolyte and hydroxyethyl starch 130/0.4 and electrolyte injection.The crystal-colloid ratio was 1:lAfter the chest was closed,manual lung retension was performed and bilateral lung ventilation was performed.All general anesthesia drugs were discontinued 5 minutes before the end of the operation.Sent patients to the postanesthesia care unit.After the patients recover spontaneous breathing,muscle strength and consciousness,the tracheal tube was removed.The intraoperative blood pressure was maintained at ±20%of preoperative,when MAP<60 mmHg or HR<50 times/min,considered hypotension or bradycardia,respectively to the corresponding cardiovascular active drugs for treatment.Monitoring the change of bispectral index(BIS),group P maintained BIS 40-60 by adjusting the propofol pump dose and group S by adjusting the sevoflurane inhalation concentration.The heart rate(HR)and mean arterial pressure(MAP)were observed before anesthesia induction(T0),before OLV(T1),OLVlh(T2),after surgery(T3).Record the operation time,one lung ventilation time,infusion and fluid loss of operation,and observe the number of hypotension(MAP<60mmHg)and bradycardia(HR<50 times/min)during the operation.Analysis of arterial blood gas at TO to T3 time.The serum concentrations of IL-6,IL-8,IL-10,and TNF-? were detected at TO,T2 and T3.Using Oxygenation Index(OI)=Pa02/Fi02 to calculate xygenation index at T0-T3 time,the pulmonary dynamic compliance(cdyn)=vt/peak formula to calculate Cdyn at t1 to t3 time.Results:1.There was no significant difference in preoperative conditions between the two groups(P>0.05).2.There was no significant difference in infusion and fluid loss of operation,one lung ventilation time,operation time in the two groups(P>0.05).There was no significant difference in incidence of bradycardia and hypotension in the two groups(P>0.05).3.Compared with the T1,the cdyn of the two groups was decreased at T2,the difference was statistically significant(P<0.05),there was no statistically difference in Cdyn between the two groups(P>0.05).There was no significant difference in OI between the two groups(P>0.05).Compared with the T1,the OI of the two groups was decreased at T2,the difference was statistically significant(P<0.05)?4.The concentrations of serum IL-6,IL-8,IL-10 and TNF-? were no significant difference between the two groups at T0(P>0.05).Compared with T0,the concentration of serum IL-6,IL-8 and TNF-? in group S and group P were both increased at T4,the difference was statistically significant(P<0.05).5.At T2 and T3,the concentration of serum IL-6?IL-8 and TNF-? in group P was significantly lower than that in group S,and the difference was statistically significant(P<0.05).At T2 and T3,the concentration of serum IL-10 in group P was significantly higher than that in group S,and the difference was statistically significant(P<0.05).Conclusion(s):We have found that one lung ventilation cause lung injury,resulting in elevated IL-6,IL-8,IL-10,and TNF-?.Dexmedetomidine combined with propofol anesthesia regimen is better than dexmedetomidine combined with sevoflurane to restrain inflammatory response,in favor of perioperative lung protection.