Effect Of Continuous Infusion Of Remifentanil On Serum MDA,SOD And SP-A In Patients With One-Lung Ventilation

Objective To observe the effect of continuous infusion of remifentanil on Serum MDA,SOD and SP-A in patients with one-lung ventilation,and to explore the protective effect of remifentanil in one-lung ventilation.Methods Forty-two patients undergoing elective radical resection of lung cancer were selected.The gender was unlimited,ASA I or II,aged 27-65 years old,heighted 152-178cm,weighted 45-88 kg,body mass index 18.49-27.46 kg/cm².They were randomly divided into remifentanil group?R group,n=21?and fentanyl group?group F,n=21?.After entering the operating room,electrocardiogram?ECG?,noninvasive blood pressure?NIBP?,heart rate?HR?,and pulse oxygen saturation?SpO₂?were routinely monitored.20G cannula needle was placed in the radial artery under local anesthesia with lidocaine to monitor the invasive blood pressure?IBP?.Midazolam 2 mg was given through venous access 30 minutes before induction.Choose intravenous anesthesia induction.After propofol TCI combined sufentanil0.5 ug/kg,cis-atracurium 0.2 mg/kg intravenous anesthesia induction,inserte double-lumen bronchial catheter?male 37F or 35F,female 35F or 32F?.Position was confirmed by fiberoptic bronchoscopy and then controlled the breath with the anesthesia machine.After changing position,fiberoptic bronchoscope was used to confirm the catheter's position correct again.During the operation,the dose of propofol was adjusted according to BIS.Anesthesia of patients in group R was maintained with continuous infusions of remifentanil at 0.1-0.5 ug/?kg·min?,and anesthesia of patients in the group F was maintained with continuous infusions of remifentanil at 0.04-0.08 ug/?kg·min?.All patients were injected with cis-atracurium0.05-0.1 mg/kg discontinuously to maintain satisfactory muscle relaxation until the end of the operation.Breath of patients was controlled by pressure controlled ventilation mode.Ventilatory settings were identical during two-lung ventilation:8-10 ml/kg PBW tidal volume,12 bpm respiratory rate,0 cmH₂O positive end expiratory pressure,FiO₂ 100%.Ventilatory settings were identical during one-lung ventilation:6-8 ml/kg PBW tidal volume,12-20 bpm respiratory rate,5 cmH₂O positive end expiratory pressure,FiO₂ 80-100%.The airway platform pressure was controlled less than 30-35 cmH₂O during operation.All patients should be drawn venous blood?used to prepare the serum?4 times,which include 10 min before anesthesia induction?T1?,60 min after OLV?T2?,3 min before TLV?T3?and 30 min after TLV?T4?,in the non-infusion side,5 ml at a time,then we will respectively test the concentration of the malondialdehyde?MDA?,activity of total superoxide dismutase?SOD?and level of pulmonary surfactant-associated protein A?SP-A?in those blood serum.Results1.General information of the two groups of patients,including age,height,weight,body mass index?BMI?,single lung ventilation side,anesthesia time,one-lung ventilation time,postoperative hospital stay days,and intraoperative anesthetic dose?except remifentanil or fentanyl?.There was no significant difference between the two groups?P>0.05?,and the difference of postoperative extubation time was statistically significant?P<0.05?.2.Comparison of MDA and SOD between the two groupsComparison between groupsThere was no significant difference in serum MDA levels in T1 to T3 between two groups?P>0.05?.The serum MDA level in group R was lower than that in group F at T4,the difference was statistically significant?P<0.05?.There was no significant difference in serum SOD activity in T1,T2,and T3?P>0.05?.The serum SOD activity of R group was higher than that of F group at T4,the difference was statistically significant?P<0.05?.Comparison within the groupCompared with T1,the serum MDA concentration of T2-T4 in both groups increased,and the serum SOD activity decreased,the difference was statistically significant?P<0.05?.3.Comparison of SP-A between the two groupsComparison between groupsThere was no significant difference in serum SP-A concentration between the two groups at the time of T1?P>0.05?.At the time of T4,the serum SP-A concentration in the R group was lower than that in the F group?P<0.05?.Group comparisonCompared with T1,the serum SP-A concentration at the T4 time of the two groups increased,the difference was statistically significant?P<0.05?.4.Correlation analysis of each observation indexIn this study,SOD and MDA have a high negative correlation?r=-0.915?,SOD and SP-A have a low negative correlation?r=-0.271?,and MDA and SP-A have a low positive correlation?r=0.386?.Conclusion1)One-lung ventilation may increase serum MDA concentration,and its effect may be related to the weakening of SOD activity by one-lung ventilation2)Serum sp-a concentration increased during one-lung ventilation,and continuous remifentanil infusion could reduce serum sp-a concentration during one-lung ventilation;3)Continuous intraoperative infusion of remifentanil has a certain lung protective effect on patients with one-lung ventilation,and the mechanism may be related to the inhibition of SOD activity during one-lung ventilation.