ABSTRACT
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ABSTRACT
Objective To evaluate the effect of extremity ischemia preconditioning on lung protection in patients undergoing pulmonary lobectomy,and to further explore its possible mecha-nisms.Methods Forty patients (male 26 and female 14,BMI 20-28 kg/m2,ASA Ⅰ or Ⅱ,aged 45-64 years old)scheduled for elective pulmonary lobectomy via a thoracoscope,were randomly divided into two groups:extremity ischemic preconditioning group (group P)had the left leg roots tied with a tourniquet,lower extremity blood flow aerated blocked for 5 min,then deflated to restore blood flow for 5 min,the cycle was repeated three times;control group (group C)had the left lower extremity tied but not charged for 30 min.All the patients underwent intravenous-inhaled composite anesthesia. Arterial and venous blood samples were taken after admission to the operating room,at 6 h,12 h and 24 h after operation.The alveolar-arterial oxygen pressure difference (PA-aO2),respiratory index(RI) and oxygenation index (OI)were calculated.The level of TLR4 was measured.The pulmonary com-plications within 48 h after operation were recorded.The adverse reactions of the left lower extremity of the group P were recorded.Results Compared with the admission to the operating room,the ex-pression of TLR4 was significantly increased in the two groups at 6 h,12 h and 24 h after operation, but the expression of the group P was significantly lower than that of group C (P<0.05).Compared with the admission to the operating room,PA-aO2and RI were significantly increased,and OI was sig-nificantly decreased in the two groups at 6 h,12 h and 24 h after operation (P<0.05).Compared with group C,PA-aO2and RI were significantly decreased,and OI was significantly increased in group P (P<0.05).There was no statistically significant difference in the incidence of pneumonia and ate-lectasis in the two groups after operation,and no respiratory failure was observed in both groups.The left lower extremity of the group P had no adverse reactions,such as rupture of skin,thromboembo-lism,and nerve injury.Conclusion Extremity ischemic preconditioning has protective effect on pul-monary function in the patients undergoing pulmonary lobectomy,which may be related to down-reg-ulation of TLR4 expression in monocytes of blood and inhibition of the systemic inflammatory re-sponse.
ABSTRACT
Objective To evaluate the effect of extremity ischemic preconditioning on the expression of aquaporin 1 (AQP1) in the lung tissues of patients undergoing pulmonary lobectomy.Methods Forty-six American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 30-64 yr,weighing 50-80 kg,scheduled for elective pulmonary lobectomy performed via a thoracoscope,were randomly divided into 2 groups (n =23 each) using a random number table:control group (group C) and extremity ischemic preconditioning group (group R).After induction of anesthesia,the patients were intubated with the double-lumen tube.Correct position of the tube was verified with the fiberoptic bronchoscope.In group R,ischemic preconditioning was induced by 3 cycles of 5-min lower extremity ischemia followed by 5-min reperfusion after induction of anesthesia.Lung tissues were obtained when the lobe of the lung was removed during surgery for determination of AQP1 expression (by Western blot) and wet/dry lung weight ratio and for microscopic examination of pathologic changes which were scored.Immediately after onset of one-lung ventilation,at 30 and 60 min of one-lung ventilation,and at 1 h after restoration of two-lung ventilation,arterial blood samples were collected for blood gas analysis,and the oxygenation index was calculated.The development of postoperative complications and length of postoperative hospital stay were recorded.Results Compared with group C,the expression of AQP1 was significantly up-regulated,and oxygenation index at 30 and 60 min of one-lung ventilation and 1 h after restoration of two-lung ventilation were significantly increased,the pathologic score,the wet/dry lung weight ratio and incidence of postoperative pneumonia and atelectasis were significantly decreased,and the length of postoperative hospital stay was significantly shortened in group R (P＜ 0.05).Conclusion Extremity ischemic preconditioning can reduce lung injury through up-regulating AQP1 expression in the patients undergoing pulmonary lobectomy.