Effects of dexmedetomidine on perioperative intrapulmonary shunt rate, inflammatory factors and Claudin-4 in patients undergoing radical operation of esophageal cancer

Wei LIU; Dongyan GAO; Li ZHANG

ABSTRACT

Objective:

To explore the effects of dexmedetomidine (Dex) on perioperative intrapulmonary shunt rate (Qs/Qt), inflammatory factors and Claudin-4 in patients with esophageal cancer undergoing radical operation.

Methods:

Sixty patients with thoraco-laparoscopic combined esophageal cancer radical resection under general anesthesia were selected from the Second Hospital of Shanxi Medical University from March to August 2018. The patients were divided into Dex group (observation group) and 0.9% sodium chloride injection group (control group) according to the random number table method, and both groups were given the same anesthesia. In the observation group, Dex was injected intravenously before the anesthesia induction, the infusion was first performed at the loading dose of 1.0 μg/kg (the infusion was completed in 10 minutes) and then the infusion was performed at the rate of 0.4 μg·kg -1·h -1 until 30 minutes before the end of the operation. The control group was injected with the same dose of 0.9% sodium chloride injection. The radial artery blood and the subclavian venous blood was collected from the two groups at four time points of double lung ventilation for 15 minutes (T 0), 30 minutes (T 1) and 1 hour (T 2) after one-lung ventilation and 30 minutes (T 3) after the restoration of bipulmonary ventilation. The blood gas was analyzed, and Qs/Qt was calculated. The blood samples from subclavian vein were collected, and the serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and Claudin-4 were measured by enzyme-linked immunosorbent assay.

Results:

The Qs/Qt in the control group at T 0, T 1, T 2 and T 3 were (13.6±3.6)%, (36.1±2.9)%, (31.8±2.4)%, and (15.3±3.2)%, the difference was statistically significant, ( F = 397.273, P < 0.01), and the Qs/Qt in the observation group were (12.5±1.8)%, (27.4±3.0)%, (27.7±4.2)%, and (13.9±3.4)%, the difference was statistically significant, ( F = 205.124, P < 0.01); the Qs/Qt in the observation group at T 1 and T 2 were significantly lower than those in the control group ( t values were 178.011 and 23.791, both P < 0.05). The concentrations of TNF-α in the control group at T 0, T 1, T 2 and T 3 were (12.4±2.4) pg/ml, (20.5±3.0) pg/ml, (24.8±4.1) pg/ml, and (34.3±8.0) pg/ml, the difference was statistically significant, ( F = 109.749, P < 0.01), and the concentrations of TNF-α in the observation group were (11.4±3.0) pg/ml, (17.6±2.8) pg/ml, (17.4±3.2) pg/ml, and (26.2±5.0) pg/ml, the difference was statistically significant, ( F = 87.653, P < 0.01); the concentrations of TNF-α in the observation group at T 1, T 2 and T 3 were significantly lower than those in the control group ( t values were 10.471, 44.730 and 24.132, all P < 0.05). The concentrations of IL-6 in the control group at T 0, T 1, T 2 and T 3 were (18.4±4.0) pg/ml, (28.5±5.4) pg/ml, (40.1±6.0) pg/ml, and (43.1±6.0) pg/ml, the difference was statistically significant, ( F = 200.151, P < 0.01), and the concentrations of IL-6 in the observation group were (17.7±4.8) pg/ml, (21.9±3.9) pg/ml, (24.8±4.6) pg/ml, and (24.0±3.8) pg/ml ( F = 14.655, P < 0.01); the concentrations of IL-6 in the observation group at T 1, T 2 and T 3 were significantly lower than those in the control group ( t values were 38.983, 120.110 and 594.878, all P < 0.01). The concentrations of Claudin-4 in the control group at T 0, T 1, T 2 and T 3 were (5.9±0.8) ng/ml, (13.6±1.8) ng/ml, (14.7±4.5) ng/ml, and (16.8±2.5) ng/ml, the difference was statistically significant, ( F = 89.332, P < 0.01), the concentrations of Claudin-4 in the observation group were (5.5±0.7) ng/ml, (16.8±1.8) ng/ml, (18.0±4.8) ng/ml, and (21.2±4.4) ng/ml, the difference was statistically significant, ( F = 120.367, P < 0.01), the concentrations of Claudin-4 in the observation group at T 1, T 2 and T 3 were significantly higher than those in the control group ( t values were 54.619, 7.112 and 18.766, all P < 0.05).

Conclusion:

Dex can improve the intrapulmonary shunt to some extent, inhibit the inflammatory response during the operation, and increase the level of Claudin-4, which plays an active role in perioperative lung protection.