Propofol Maintenance Anesthesia for Lung Protection in Patients Undergoing One-lung Ventilation.
ZHAO Zhen-ru,MIAO Li-na,WANG Jing-jing,LIU Jun
Department of Anesthesiology, Chengde Central Hospital of Hebei Province, Chengde(067000), China;Ningxia Medical University (Yinchuan 750004);Department of Anesthesiology, General Hospital of Ningxia Medical University (Yinchuan 750004)
Abstract:
Objective To compare the effects of propofol and sevoflurane anesthesia maintain on inflammatory cytokines and Oxidation - antioxidant balance during perioperative period in patients undergoing one-lung ventilation and to discuss the mechanism of different anesthesia maintain induced lung protection. Methods Forty ASAⅠorⅡpatients(24 male, 16 female)aged 45-70 yr underwent elective pulmonary resection were observed. Anesthesia induction is practiced in two groups by intravenous injection: Midazolam 0.05mg/kg, Sufentanil 0.3~0.5ug/kg, Etomidate 0.15~0.3 mg/kg, Cisatracurium Besilate0.2mg/kg, anesthesia maintain were randomly divided into two groups(n=20 each); continuous intravenous Propofol infusion 4~10mg/(kg·h) with miero-Pump(GroupⅠ)and inhaled l%~3% sevoflurane(GroupⅡ). Aterial blood concentrations of IL-6、IL-10、MDA and SOD were measured at before induction of anesthesia( T0) ,before the start of one-lung ventilation( T1),30 min after one-lung ventilation( T2), and at the end of the operation( T3). Results Compared within group, the concentrations of IL-6, IL-10 and MDA in propofol group at T2 were (64.8+26.4) ng/L, (176.6+41.8) ng/L, (6.7+1.5) mmol/L, and the above-mentioned indexes at T3 were (79.2+29.1) ng/L, (197.8+51.2) ng/L, (8.2+1.9) mmol/L respectively, which were significantly lower than those at T0 (P<0.05). The concentration of SOD at T2 and T3 were (66.6+7.0) U/L and (69.6+6.2) U/L, which were significantly higher than those at T0 (P<0.05); the concentration of IL-6, IL-10 and MDA at T2 in sevoflurane group were (82.3+26.1) ng/L, (152.9+28.3) ng/L, (7.9+1.3) mmol/L, and the above indexes at T3 were (96.3+18.4) ng/L, (1.3) ng/L, respectively. The concentration of SOD at T2 and T3 were (65.3 + 9.0) U/L and (58.8 + 8.5) U/L, respectively, which were significantly higher than that at T0 (P < 0.05). The concentration of SOD at T2 and T3 was (65.3 + 9.0) U/L and (58.8 + 8.5) U/L, which were significantly lower than that at T0 (P < 0.05). The IL-6/IL-10 ratio of propofol group was lower than that of T0 at each time point, while the IL-6/IL-10 ratio of sevoflurane group was higher than that of T0 at T2 and T3 (P < 0.05). Compared with sevoflurane group, there was no significant difference in the propofol group at T1 (P > 0.05); the concentration of IL-10 and SOD in propofol group at T2 and T3 increased significantly (P < 0.05), while the concentration of IL-6 and MDA decreased significantly (P < 0.05). The IL-6/IL-10 ratio of sevoflurane group at T1, T2 and T3 were higher than that of propofol group at corresponding time points (P < 0.05). Conclusion Propofol anesthesia maintain was more conducive to maintaining with pro-inflammatory cytokines and anti-inflammatory cytokines balance, oxidation and antioxidant balance in patients undergoing one-lung ventilation. It may protect the lung from the injury during one-lung ventilation.
