ABSTRACT
ObjectiveTo evaluate the efficacy of PEEP set according to pressure-volume (P-V) curve for one lung ventilation (OLV) in patients undergoing thoracic surgery.MethodsOne hundred and twenty ASA Ⅱ or Ⅲ patients of both sexes aged 20-60 yr weighing 40-80 kg undergoing lobectomy under general anesthesia were enrolled in this study.Double lumen tube was inserted.Correct positioning was verified by fiberoptic bronchoscopy.The patients were mechanically ventilated.P-V curve was determined at 3 min of two-lung ventilation (TLV).Lower inflection point (LIP) was measured and the pressure at LIP (PLIP) was recorded.The patients were randomly divided into 5 groups (n ＝ 24 each):control group (group C) and 4 lung protective ventilation regimen groups ( groups P1-4 ).PEEP was set at 0 and VT was set at 10 ml/kg in group C.PEEP was set at 0 and VT was set at 6 ml/kg in group P1.PEEP was set at PLIP- 2 cm H2O and VT was set at 6 ml/kg in group P2.PEEP was set at PLIP and VT was set at 6 ml/kg in group P3.PEEP was set at PLIP + 2 cm H2O and VT was set at 6 ml/kg in group P4.Peak airway pressure (Ppeak),plateau airway pressure (Pplat),airway resistance (Raw) and lung compliance (CL ) were measured and recorded during OLV and TLV after a period of stabilization.Arterial blood samples were taken before induction of anesthesia and at 20 min of TLV and 20 min of OLV for blood gas analysis.Qs/Qt was calculated.Arterial blood samples were collected at the beginning and end of OLV for determination of plasma concentrations of IL-6 and TNF-α(by ELISA).ResultsCompared with group C,Ppeak and Pplat were significantly increased while Raw was decreased and plasma IL-6 concentration was significantly decreased at the end of OLV in group P4.PaCO2 was significantly higher during TLV and OLV in groups P1-4 than in group C.There was no significant difference in the parameters of respiratory mechanics,blood gases and plasma IL-6 and TNF-α concentrations among groups P1,2.3.Compared with groups P1,2,3,Ppeak and Pplat were significantly increased while plasma IL-6 concentration was decreased at the end of OLV in group P4.ConclusionMechanical ventilation with VT set at 6ml/kg and PEEP at PLIP + 2 cm H2 O provides best venfilatory efficacy for OLV in terms of oxygenation and inhibition of inflammatory response.
ABSTRACT
<p><b>BACKGROUND AND OBJECTIVE</b>It ha been proven that serum vascular endothelial growth factor (VEGF) concentration was elevated significantly after surgery in patients of non-small cell lung cancer (NSCLC). Platelet may be the main resource of serum VEGF. The aim of this study is to investigate the correlation between postoperative dynamic changes of serum VEGF levels and platelet counts in patients of NSCLC who underwent surgery.</p><p><b>METHODS</b>Serum VEGF levels were determined in 76 patients of NSCLC who were treated with surgery by ELISA (enzyme linked immunosorbent assay) method before operation and on postoperative day 1, 7. At the same day the concentrations of platelet were determined. RESULTS (1) Serum VEGF in patients of NSCLC on preoperative day, postoperative 1 day and 7 day were (842.06 +/- 527.24) pg/mL, (1 119.28 +/- 609.62) pg/mL, (1 574.09 +/- 873.38) pg/mL, respectively (P < 0.001); (2) Platelet counts in patients of NSCLC on preoperative day, postoperative 1 day and 7 day were (230.42 +/- 82.56 x 10(9)/L, (196.47 +/- 81.48) x 10(9)/L, (237.90 +/- 86.94) x 10(9)/L; the value on postoperative 1 day was the lowest (P < 0.001); (3) On postoperative 7 day, serum VEGF in the group of lower than the mean and higher than the mean were respectively (1 398.81 +/- 734.00) pg/mL and (1 842.86 +/- 1 006.63) pg/mL (P = 0.043).</p><p><b>CONCLUSION</b>Serum VEGF in patients of NSCLC after surgery were elevated. In the group of higher platelet counts, serum VEGF increased more significantly.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Carcinoma, Non-Small-Cell Lung , Blood , General Surgery , Enzyme-Linked Immunosorbent Assay , Lung Neoplasms , Blood , General Surgery , Platelet Count , Postoperative Period , Vascular Endothelial Growth Factors , BloodABSTRACT
@#ObjectiveTo observe the effect and safety of continuous epidural analgesia with sufentanil in different concentrations combined with 0.125% bupivacaine on pain after thoracotomy.Methods30 patients with ASA grade Ⅱ～Ⅲ and underwent thoracotomy were randomly divided into 3 groups treated with 0.125% bupivacaine combined with sufentanil 0.25 μg/ml (group A), 0.50 μg/ml (group B) and 0.75 μg/ml (group C) respectively. Before operation starting, epidural puncture was performed at T7～T8 and a catheter was put in. After operation, continuous epidural analgesia was performed by connecting the catheter and a analgesic pump. Analgesia effect was evaluated by visual analogous score (VAS) at sixth, twelfth, twenty-fourth and forty-eighth hours after operation. Dosage of assistant drug and side effects such as calmness, nausea, vomiting, skin pruritus and respiratory inhibition were also recorded.ResultsVAS scores and dosage of assistant drug of group B and group C were not different, but they were all lower than that of group A (P<0.05). Scores of skin pruritus of group A and group B were lower than that of group C (P<0.05), but there was no significant difference between group A and group B. No respiratory inhibition occurred in patients of all three groups.ConclusionContinuous epidural analgesia of 0.50 μg/ml sufentanil combined with 0.125% bupivacaine is safe and effective for patients after thoracotomy.