The Protective Effect Of Sevoflurane On Lung Injury Induced By One-lung Ventilation And Its Mechanism

Objective Sevoflurane is commonly used in clinical inhalation anesthetics, havebeen found on many vital organs, ischemia/reperfusion injury has a protective effect.But the protective effect of sevoflurane, on the one-lung ventilation induced lunginjury has not been reported, this study at different time points were measured inplasma IL-8, TNF-a content of arterial blood gas and lung tissue water channelprotein (Aquaporin, AQP)14expression was recorded lung pathological changes, toobserve the influence of sevoflurane on one-lung ventilation induced lung injury andto explore its mechanism.Methods Be undergoing open lobectomy in61cases of lung cancer patients forthe study,33males and28females, were randomly divided into control group in thepropofol group (Ⅰ group, n=29) and sevoflurane group (II n=32cases), ASA II~~class III, one-lung ventilation time>120min. Exclusion indicators: preoperativeradiotherapy, chemotherapy, immunotherapy of patients; preoperative lung infection;patients with hypoproteinemia; chronic lung disease and a history of asthma; sidedDLT bit poor.The same two groups of patients induction of anesthesia, anesthesiawas maintained in group I were treated with propofol target-controlled infusion,group II patients with sevoflurane anesthesia to the end of surgery.Induction ofanesthesia before5min (T1), single-lung ventilation90min (T2), and surgery, lungventilation30min (T3) to take the radial artery measurements of IL-8and TNF-concentration, arterial blood gas analysis.All patients in the thoracotomy todetermine the cut in the pre-resection of the lobe lobectomy a normal lung tissue(from the cancer tumors>5cm). Until the lobe in vitro, in the materials near thesite of the first piece of lung tissue was cut the second block of lung tissue,determination of the two lung AQP1of AQP4expression and HE staining for pathological morphology. Statistical analysis: data using statistical softwareSPSS13.0processing measurement data using the mean±standard deviation ( x±s)between the two groups were compared using analysis of variance.Results The two groups of patients before surgery in general, the difference wasstatistically significant (P>0.05). IL-8, TNF-a change: Compared with T1, T2,T3groups were significantly higher (P <0.05), especially in the higher group Ⅰmore obvious difference was statistically significant (P <0.01). T2, T3, ⅱ and ⅰgroup, the difference was significant (P <0.05).Oxygenation index changes:Compared with T1, T2group were lower (P <0.05), especially in group Ⅰ reducethe more obvious (P <0.01). Changes in AQP1and AQP4: the first piece of lungtissue AQP1expression was no significant difference compared with the first piece oflung tissue, the second block of lung tissue in group Ⅰ and group Ⅱ AQP1andAQP4expression differences (P>0.05); statistically significant (P <0.05).HEstaining of two groups of patients with pulmonary pathomorphology: the first one thetwo groups of patients with lung organization lobular structure is clear, pathologicalnormal alveolar space clean, alveolar interstitium with no or few inflammatory cellsinfiltration, alveolar wall thickening. The second block of the group Ⅰ patientslobular structures of the lung tissue disorders, and normal lung tissue morphologicaldamage in alveolar exudation and hemorrhage, alveolar type Ⅰ and type Ⅱ cellstructure is not clear. Group Ⅱ second block of the lobular structure of the lungtissue disorders, lung tissue morphology remained in alveolar exudation andhemorrhage, interstitial lung a small amount of inflammatory cell infiltration,alveolar space, a small amount of oozing and bleeding, lung tissue The pathologicalchanges than group Ⅰ light.Conclusion (1) IL-8, TNF-a, of AQP1in, of AQP4are involved in single-lungventilation-induced lung injury;(2) in one-lung ventilation, sevoflurane can reducearterial blood IL-8and TNF-a, increase the expression of AQP1and AQP4, toimprove the level of oxygenation, and improve the role of one-lung ventilation due to the pathological features; sevoflurane (3) application of a one-lung ventilation-induced lung injury protection role.