ABSTRACT
Objective To investigate the effect of perioperative pulmonary infection in elderly patients with mild to moderate chronic obstructive pulmonary disease (COPD) undergoing general anesthesia.Methods Forty elderly patients undergoing general anesthesia and abdominal surgery, 24 males, 16 females, aged 65-81 years, ASA physical status Ⅰ-Ⅲ, BMI 19-28 kg/m2, were randomly divided into two groups (n=20 each): protective ventilation group (group PV) and conventional ventilation group (group CV).Lung protective ventilation was received in group PV: intermittent positive pressure ventilation, tidal volume 6 ml/kg (ideal body weight), positive end expiratory pressure (PEEP) 5-10 cm H2O, alveolar recruitment maneuver every 30 minutes;conventional ventilation was received in group CV: intermittent positive pressure ventilation, tidal volume 10 ml/kg (ideal body weight), without using the PEEP and alveolar recruitment maneuver.Venous blood samples for interleukin 6 (IL-6) and interleukin-8 (IL-8) were taken at five different time points: before the anesthesia induction (T1), 2 h after mechanical ventilation (T2), at the end of operation (T3), 6 h (T4) and 24 h (T5) after operation.The clinical pulmonary infection score (CPIS) was recorded at before anesthesia, days 1, 3, 5 and 7 after surgery.The incidence of postoperative pulmonary inflammation was also recorded.Results There was no statistical difference in the two groups with respect to age, body mass index, ASA physical status, intraoperative volume of infusion, estimated blood loss, urine volume, mechanical ventilation time, operation method and IL-6, IL-8 levels at T1-T5.Compared with T1, the IL-6 and IL-8 levels in two groups at T2-T5 increased significantly (P＜0.05).Compared that before anesthesia, CPIS in group CV on postoperative days 1, 3 and 5 increased significantly (P＜0.05);compared with group CV, CPIS and the incidence of postoperative pulmonary inflammation in group PV reduced significantly on postoperative days 1, 3 and 5 (P＜0.05).Conclusion Lung protective ventilation can not reduce perioperative IL-6, IL-8 levels in laparotomy elderly patients with COPD, but it can reduce the incidence of pulmonary inflammation and pulmonary infection within 5 postoperative days.
ABSTRACT
Objective To investigate the change of cardiac troponin Ⅰ (cTn Ⅰ),interleukin (IL)-6 in patients undergoing cardiac valve replacement and compare the degrees of fentanil,sufentanil,and remifentanil on myocardial protection and inhibiting effect of inflammatory.Methods Forty-eight patients,undergoing cardiac valve replacement,were randomly divided into three groups (n =16):remifentanil (group R),sufentanil (group S),and fentanil (group F).All the patients were total intravenous anesthesia of midazolam,opioid,vecuronim,and propofol.Different opioids were used in each group.Group R was induced with remifentanyl 1 ～2 μg/kg and maintained at a rate of 1 ～4 μg/(kg · min).Group S was induced with sufentanyl 1 ～2 μg/kg and maintained at a rate of 1 ～4 μg/(kg · h).Group F was induced with fentanyl 5 ～ 10 μg/kg and maintained at a rate of 10 ～30 μg/(kg · h).Blood samples were taken before anesthesia (T0),twenty minutes after aortic declamping (T1),the end of operation (T2),6 h (T3),and 24 h (T4) after cardiopulmonary bypass (CPB) for determination of plasma concentration of troponinⅠ and IL-6.Results Compared to T0,cTn Ⅰ and IL-6 in three group at T1,T2,T3 were significantly higher (P ＜ 0.05),cTn Ⅰ reached the peak level at T4 (P ＜ 0.05),IL-6 reached the peak level at T3 (P ＜ 0.05).Compared to group F,cTn Ⅰ and IL-6 in groups S and R at T1,T2,T3,and T4 decreased significantly (P ＜0.05).Conclusion Compared to fentanil,sufentanil and remifentanil had comparative advantages on lessening myocardial injury and inhibiting effect of inflammatory for patients who are undergoing cardiac valve replacement.