Study On The Characteristics Of Lung Injury Index Of Exhaled Condensate And Serum In 104 Patients Undergoing Hip Or Knee Replacement

Objective:In this study,we selected 104 patients undergoing hip or knee replacement to investigate the occurrence of perioperative lung injury in these patients and its possible influencing factors by observing and analyzing the respiratory mechanics indexes of patients during general anesthesia,as well as the changes of lung injury biological indexes exhaled gas condensate and serum during operation.The results are helpful to provide scientific methods and theoretical basis for lung protection and rehabilitation after hip or knee replacement.Methods:104 patients were selected underwent hip or knee replacement in the operating room of Nanjing Drum Tower hospital from June to December 2018.General data of patients were collected,and clinical indicators such as intraoperative vital signs,access volume,respiratory mechanical parameters and oxygenation indexes after anesthesia and at the end of surgery were recorded.The collector of exhaled air condensate was connected to the front of the endotracheal tube,and the condensate collector collected the exhaled air condensate 1h and 2h after the endotracheal intubation induced by anesthesia,respectively.Arterial blood was extracted at two time points after anesthesia induction?T1?and 30min after tracheal tube removal?T4?.Biological indicators for detecting lung injury in condensed fluid and serum:Plasma tumor necrosis factor alpha?TNF-??,Clara cell secretory protein?CC16?,Advanced glycosylation end products Soluble receptor(Soluble receptor for advanced glycation end products,soluble receptor for advanced glycation end-products?s RAGE?,Surfactant proteins?SP-D?,etc.According to the general situation of the patients,preoperative laboratory examination,clinical indicators after anesthesia,intraoperative respiratory mechanical parameters and and oxygenation indexes,as well as serum and condensate lung injury indicators were grouped respectively.SPSS18.0 statistical software was used for statistical analysis,the measurement data were expressed as x±s,and the homogeneity test of variance and t test were used for comparative analysis.Chi-square test was performed for the variables,and P<0.05 was considered statistically significant.Results1?The peak pressure?T2?and serum s RAGE levels were significantly lower in the hypertension and diabetes group?38 cases?than in the hypertension or diabetes group?46 cases?,and the group without hypertension or diabetes?20 cases??P<0.05?.2?The MMP9?2h?level were significantly lower in the preoperative neutrophil-lymphocyte ratio?NLR?>4 group?31 cases?,compared with the 0-2group?38 cases?and 2-4 group?35 cases??P<0.05?.3?The MMP9?2h?and total protein?2h?of condensate levels in the preoperative C-reactive protein?CRP??8?g/L group?73 cases?were significantly reduced compared with those in the>8?g/L group?31 cases??P<0.05?.4?The serum s RAGE levels in the preoperative erythrocyte sedimentation?ESR??20mm/h group?72 cases?were significantly increased compared with those in the>20mm/h group?32 cases??P<0.05?.5?Compared with patients in the preoperative total protein70-80g/L group?23 cases?and the 60-70g/L group?69 cases?,MMP9?2h?levels of condensate significantly increased?P<0.05?.Compared with patients in the 60-70g/L group and the 70-80g/L group,MPO?2h?levels of condensate were significantly reduced in the group<60g/L?12 cases??P<0.05?.Compared with patients in the group preoperative albumin<40g/L?42 cases?and the group>40g/L?62 cases?,serum SP-D levels was significantly increased after operation?P<0.05?,and serum TNF-?levels was significantly decreased after operation?P<0.05?6?Lung compliance?T2?,oxygenation index?T2?and condensate MMP9?2h?were significantly decreased with the increase of average pressure?T1??P<0.05?.Compared with the patients in the group peak pressure?T1?value?16 cm H₂O?51cases?and the group>16 cm H₂O?53 cases?,the serum s RAGE level index significantly increased after operation,the levels of TNF-??2h?in the condensate decreased significantly?P<0.05?.The serum s RAGE levels were significantly reduced in the lung compliance?T1?values?35 group?59 cases?compared with the>35 group?35 cases??P<0.05?.7?Postoperative serum TNF-?levels were significantly increased in the total condensed liquid protein?1h?level>9000?g/ml group?15 cases?,<8000?g/ml group?32 cases?,8000-8500?g/ml group?28 cases?and 8500-9000?g/ml group?29 cases??P<0.05?.The levels of condensate SP-D?2h?were significantly reduced in the>9000?g/ml group and the<8000?g/ml group?P<0.05?.Conclusions:1.Partial indexes of serum and condensate lung injury in patients showed an increasing or decreasing trend with the preoperative drenthe ratio,CRP level,total protein level and albumin level,which suggests that appropriate inflammatory pretreatment may play a role in reducing the incidence of lung injury.Patients with hypoproteinemia were assessed for lack of specificity in the occurrence of lung injury by serum s RAGE level after surgery,the prediction of MPO?2h?and TNF-??2h?levels in condensate is more clinically significant.2.Serum s RAGE and lung injury index in condensate increased significantly with the decrease of airway pressure and the increase of lung compliance.It is suggested that appropriate airway pressure can support alveoli to a certain extent.To minimize alveolar collapse and maximum volume of alveolar expansion should be a goal,and setting appropriate PEEP could minimize the mechanical ventilation leading to lung injury.