Lung Protection Role Of Dexmedetomidine Combined With Penehyclidine Hydrochloride For Patients With One-lung Ventilation

[Objective]:To study lung protection of dexmedetomidine (Dex) combined with penehyclidine hydrochloride(PHC) used for patients with one-lung ventilation(OLV) before induction of anesthesia, for purpose of providing further theoretical basis for the clinical application of anesthesia-related drugs to improve lung injury caused by one-lung ventilation.[Methods]:Eight patients with lung cancer in our hospital for a radical treatme nt was collected out as the research object.all patients with lung cancer classifi ed as Class Ⅱ or Class Ⅲ.After the former full preoperative preparation,all pa tients were to be ASA grade Ⅰ-11 level.A randomized, controlled,double-blinde d investigating method was employed,eighty patients were randomly divided int o four groups (n=20):Dex group (group D),PHC group (group P),Dex combine d with PHC group (group D+P),control group (group C).Dose test intervention s:D group given dexmedetomidine infusion 0.8μg/kg (diluted with saline to 20ml); P group given hydrochloride infusion 10μg/kg (diluted with saline to 2 Oml); D+P group:Dex given 0.8μg/kg+PHC10μg/kg (diluted with saline to 20ml); 20ml of normal saline infusion in group C; Then anesthesia induction midazolam 0.05mg/kg, fentanyl 3μg/kg, etomidate 0.15mg/kg, rocuronium 0.6mg/kg were given through vein.Until the patient consciousnessdisappeared, muscle relaxation and blood pressure, heart rate steady,endotracheal intubation through oral and placed bronchial occlusive tube (ID No.8), and then confir m closure location correctly by direct observation through the bronchoscopy an d auscultation.Meanwhile.control of breathing by anesthesia machine, capacity-controlled mechanical ventilation, breath parameters based on the patient’s weig ht:tidal volume (VT) is 8ml/kg, respiratory ratio (I:E) is 1:2, respiratory r ate (RR) of 12 times/min, fraction of inspired oxygen (FI02) was 100%, the oxygen flow rate was 2L/min. When one-lung ventilation was established, adjustrelated breathing control parameters:VT to 6ml/kg, RR 14 times/mi n, the left parameters remain unchanged. Maintenance of anesthesia:sevoflurane continuous inhalation anesthesia maintenance (end-tidal sevoflurane concentratio n fluctuation around 1MAC.Monitor the patient’s BIS value fluctuated 40-60. f entanyl and rocuroniumwere given according to BIS values, hemodynamic indic ators and surgical operation.Given medicines for symptomatic treatment during t he operation based on blood pressure and heart conditions.After the last fentan yl used,immediate postoperative intravenous analgesia was given.Analgesia form ula is:sufentanil 1μg/kg+ Azasetron dezocine 20mg+25mg+0.9% saline diluted to 100ml, pump the rate of 2ml/h.Record anesthesia time, one-lung ventilation time, operation time, blood loss, fluid volume, urine volume. Respec tively, collected arterial blood line blood gas analysis, recording PaO2, PaCO2, calculate OI, RI; while using ELISA method for the detection of interleukin ( interleukin, IL)-2, IL-6, IL-10, and tumor necrosis factor -a (tumor necrosis fa ctor-a, INF-a) concentration. Recording the patient’s tidal volume, peak airway pressure,in T1, T2, T3, and calculates the patient’s dynamic lung compliance Compared PPC and postoperative hospital stay.[Results]:1.Age, sex, weight, ASA classification, anesthesia time, operative time, OLV ti me,infusion volume,bleeding volume,urine were not statistically significant c ompared between four groups(P> 0.05).2.Respiratory mechanics index at each time point comparisonComparison at T3 between D+P group and C group about Ppeak, Cdyn,the difference was statist ically significant (P<0.01), D+P group between D or P group the difference was statistically significant (P<0.05).3.Arterial blood gas index at each time point comparison Comparison at T3 between D+P group and C group about PaO2, RI,OI, ther e was statistically significant (P<0.01), D+P group between D group or P gro up the difference was statistically significant (P<0.05).4.The concentration of inflammatory cytokine at each time point comparison(1 Concentration of IL-2, IL-6, IL-10, TNF-a in plasma at TO. the difference w as not statistically significant (P> 0.05).(2)The difference between D+P and C group about the concentrationof INF-a, I L-2, IL-6 in T3, T4, T5 time was statistically significant (P<0.05), between P or D group in T4, T5 time point was statistically significant (P<0.05).(3) The difference between D+P and C group about the concentration of IL-10 in T2, T5 time was statistically significant (P<0.05), in T3, T4time point wa s statistically significant (P<0.01).5.The difference of PPC and postoperative hospital stay was not statistically si gnificant (P> 0.05) in four groups of patients.[Conclusion]1.Patients with the one-lung ventilation,who treated undergoing lung cancer, ca n cause the body’s own stress response and lead to release of inflammatory cy tokines and may eventually cause severe inflammation,which would to be reduc e the patient intraoperative and postoperative lung function at last.2.Given dexmedetomidine or hydrochloride penehyclidine before induction of an esthesia can be applied to a certain extent, inhibit the release of perioperative i nflammatory factors, reduce the degree of inflammation and improve lung preo perative and postoperative Features.3.Dexmedetomidine and hydrochloride penehyclidine were given before inductio n of anesthesia can more effectively reduce the release of inflammatory factors, the improvement of preoperative and postoperative lung function is more obvi ous.