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Objective To assess the lung protection effect of sevoflurane on adult cardiac surgery during cardiopulmonary bypass (CPB) using Meta-analysis. Methods The databases of Cochrane library, Embase, PubMed, Google scholar,CNKI,Wanfang and Weipu were comprehensively searched by computer up to December 2017 to obtain the published literature on randomised controlled trials(RCT)of sevoflurane for lung protection under CPB.Key words included extracorporeal circulation, cardiac surgery, pulmonary protection, sevoflurane and Meta-analysis. And then a separate quality assessment and data extraction for the selected literatures were carried out by two researchers. The Meta-analysis was performed via statistical software RevMan5.3.Results Eleven RCT literatures and 440 patients in total were selected in this study, in which, 220 cases were for the sevoflurane group and 220 cases were for the total intravenous anesthesia (TIVA)group.The analysis results showed that the application of sevoflurane could significantly reduce the levels of IL-6 (P=0.005)and IL-8(P=0.01)in the blood,and decrease postoperative tracheal intubation time in CPB group compared with those of TIVA group(P<0.001).However,there were no statistical differences in the level of tumor necrosis factor-α(TNF-α) (P=0.19), the alveolar-arterial differences for oxygen[P(A-a)O2](P=0.68) and the oxygenation index OI between two groups (P=0.31). Conclusion The application of sevoflurane during CPB could effectively reduce the levels of some inflammatory factors in blood and decrease the postoperative tracheal intubation time. However, there is no adequate evidence to prove the definite lung protection effect of sevoflurane on CPB.
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Objective To explore the effect of preoperative pulmonary protection therapy on surfactant protein A(SP–A) content in lung tissue and postoperative complications. Methods Sixty patients with non-small cell lung cancer (NSCLC) complicated with chronic obstructive pulmonary disease(COPD) who underwent surgical treatment in Tianjin Chest Hospital from January 2015 to June 2016 were enrolled in this study. Thirty patients were included in the control group and 30 patients in the pulmonary protection group. The control group was given routine preoperative preparation, while the pulmonary protection group was given 1 week pulmonary protection therapy on the basis of routine preoperative preparation. The exhaled breath condensate (EBC) was collected and pulmonary function was re-checked after admission and before surgery. The content of SP-A in EBC was detected by ELISA. The lung tissue samples were collected during surgery, and the SP-A level was measured by Western blotting. Results The SP-A level of the pulmonary protection group was significantly higher than that of the control group (1.05±0.21 vs. 0.93±0.16, P0.05). The average postoperative hospital stay was statistically significant shorter in the pulmonary protection group than that in the control group[(9.2 ± 3.1) d vs. (11.6 ± 4.8) d, P<0.05]. Conclusion Preoperative pulmonary protection therapy can not only improve pulmonary function and shorten postoperative hospital stay, but also improve SP-A content in lung tissue.
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Objective To explore lung protection effect of levosimendan(LS) during cardiopulmonary bypass in canine model by ratio between dry and wet (W/D) lung tissue,concentrations of malonaldehyde (MDA) and superoxide dismutase (SOD) and alterations of histology.Methods A total of 32 canines were divided into 4 groups at random with the procedure of myocardial blocking for 1 hour and then recovering for 2 hours.Animals in 4 groups were handled as following:No any special treatment after myocardial blocking in control group(group C).Lung perfusion was performaned with cold oxygenated blood after myocardial blocking in experiment 1 group(group P).LS(65 μg/kg) was injected intravenously before thoracotomy in experiment 2 group(group LSIV) and remaining procedure was same to the control one.Combined with LS (65 μg/kg),lungperfusion was performaned with cold oxygenated blood after myocardial blocking in experiment 3 group(group LSP).Right lung tissue of canines was taken immediately after the study for observing pathological alterations and measuring the concentrations of MDA and SOD through corresponding procedure.Results Compared with group C,the ratios of W/D and the concentrations of MDA were lower significantly,while those of SOD were higher significantly(P ＜ 0.05).Compared with group P and LSIV,the concentration of MDA was lower significantly,while that of SOD was higher significantly(P ＜ 0.05).There was no significant difference between group P and LSIV(P ＞0.05).Less impairment of lung tissue was found after LS intervention by light and electric microscope.Conclusion LS plays an important role in protecting lung tissue,based on founding in canine model,with decreasing ration of W/D and concentration of MDA and increasing that of SOD by both intravenous injection and lung perfusion.
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Objective To study the pulmonary protective effect of large dose of ambroxol hydrochloride injection in postoperative patients with severe hypertensive intracerebral hemorrhage.Methods One hundred and sixty postoperative patients with hypertensive intracerebral hemorrhage were selected,and the patients were divided into conventional dose group and large dose group by random digits table method with 80 cases each.The therapeutic effect,partial pressure of oxygen,oxygenation index,acute physiology and chronic health evaluation Ⅱ score,antibiotic application time and hospitalization period in intensive care unit were compared between 2 groups.Results After treatment,the partial pressure of oxygen and oxygenation index in large dose group were significantly better than those in conventional dose group:(94.7 ± 7.2) mmHg (1 mmHg =0.133 kPa) vs.(86.5 ± 8.1) mmHg and (420.3 ± 35.5) mmHg vs.(356.0 ± 28.7) mmHg,the acute physiology and chronic health evaluation Ⅱ score was significantly lower than that in conventional dose group:(8.2 ± 3.4) scores vs.(11.6 ± 3.5) scores,the antibiotic application time and hospitalization period in intensive care unit were significantly shorter than those in conventional dose group:(8.5 ± 3.7) d vs.(13.4 ± 5.8) d and (7.3 ± 2.5) d vs.(9.7 ± 5.2) d,and there were statistical differences (P＜ 0.05).The total effective rate in large dose group was significantly higher than that in conventional dose group:92.5％ (74/80) vs.83.8％ (67/80),and there was statistical difference (P ＜ 0.05).Conclusion The pulmonary protective effect of large dose of ambroxol hydrochloride injection is significant in postoperative patients with hypertensive intracerebral hemorrhage.
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Objective To study the effect of intratracheal anti-tumor necrosis factor-α antibody(TNF-αAb)on ultra-structure of lung after cardiopulmonary bypass(CPB).Method 28 healthy rabbits were selected and randomly evenly divided into four groups:I group only received open chest operation;Ⅱ-Ⅳ groups underwent CPB.In the IV group,rabbit TNF-α Ab (2400 ps/kg)Was dropped into the intracheal tube before operation and just after releasing the aortic clamp.Saline was given to the Ⅲ group by the same way.Water volume,TNF-α mRNA,TNF-α protein,apoptosis and pathomorphological changes were measured in the lung tissues.Results TNF-α Ab can re-duce releasing of TNF-α.It could also reduce the occurrence of apeptosis and attenuate pathomorphological changes in the lung tissue.Conclusion Intratracheal TNF-α Ab markedly lessenes the injury of nltrastructure of lung after CPB.
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Objetivo: Estudar o papel do probucol na lesão pulmonar obtida pela administração de doxorrubicina em ratos. Método: foi realizado um estudo piloto experimental, onde o probucol foi testado como protetor da injúria pulmonar obtida pela administração de doxorrubicina em ratos. Resultados: Na análise comparativa dos grupos, estudados por microscopia óptica, não houve diferença significativa de critérios previamente definidos, exceto pelo edema pleural (p < 0,05). Já na microscopia eletrônica, a agressão da doxorrubicina foi identificada através da desorganização estrutural. No grupo que recebeu probucol e doxorrubicina, não foi observada a mesma desorganização (p < 0,05). Conclusões: os resultados deste estudo piloto sugerem que o probucol exerceu um efeito protetor no tecido pulmonar agredido pela doxorrubicina e que a microscopia eletrônica é mais sensível na identificação de critérios de injúria pulmonar decorrente da exposição à doxorrubicina (AU)
Objective: To study the role of probucol in the pulmonary injury caused by doxorubicin in rats. Methods: An experimental study was carried out to verify where the probucol was protective of the pulmonary injury caused by the administration of doxorubicin in rats. Results: In the comparative analysis of the groups studied by optic microscopy, it did not have significant difference in pre-definite criterions, except for pleural edema (p < 0,05). In eletronic microscopy, the aggression of the doxorubicin was indicated through the structural disorganization. In the group that received probucol and doxorubicin was not observed the same disorganization (p < 0,05). Conclusion: The results suggest that the probucol was effective in the protection of pulmonary injury caused by doxorubicin and that the eletronic microscopy is more sensitive for pre-definite criterions of pulmonary injury (AU)