The Comparison Of The Effects Of Sevoflurane And Propofol On Lung Ischemia-Reperfusion Injury In One Lung Ventilation With Pulmonary Lobectomy

Objectives:The aim of this study is to compare sevoflurane and propofol on one lung ventilation(OLV) induced ischemia-reperfusion injury (IRI) with pulmonary lobectomy by determining the blood gas, ischemia-modified albumin (IMA), tumor necrosis factor-a (TNF-a),interleukin-6 (IL-6), interleukin-10 (IL-10),and investigate the protective effects of sevoflurane and propofol for OLV in patients with lung ischemia-reperfusion injury.Methods:Forty patients from the Third Affiliated Hospital of Kunming Medical University. The patients from September 2015 to February 2016, aged 45 to 70, body weight 45 to 75 kg, ASA physical status I and II, undergoing pneumonectomy for thoracic surgery. Forty patients in accordance with the random number table, were divided in to two groups. (Sevoflurane:Group S, n= 20 and Propofol:Group P, n= 20). The patients of preoperative pulmonary function indicators were normal. Eligible patients before surgery without hypertension, coronary atherosclerotic heart disease,diabetes, chronic obstructive pulmonary disease, pneumonia and other serious infectious diseases, no oral anti-oxidants (such as multivitamins etc.), no long-term glucocorticoid treatment history, preoperative cardiac enzymology, hepatorenal and kidney tests results showed no abnormalities, no history of radiation therapy and chemotherapy before surgery.In group S, sevoflurane 2.0%～3.0% were inhaled after bronchial intubations, minimum alveolar concentration (MAC) was maintained at level of 1.3～1.5. While in group P, the patients were supplied total intravenous anesthesia with propofol and remifentanil at the same time. Bispectral index (BIS) was monitored and maintained 40～60 during anesthesia. First blood samples for blood gas, TNF-a,IL-6, IL-10 and IMA were obtained and vital parameters were recorded before anesthesia induction (To).The blood samples were obtained at 30 min after OLV (T1),90 min after OLV (T2),2h after two lung re-ventilation(T3). Last blood samples were obtained at postoperative 24h (T4). The levels of TNF-a, IL-6, IL-10 and IMA were measured and the varying trends were observed.Results:There were no significant differences between two groups in general information. The data of intraoperative such as MAP, Hb, PaO2 and PaCO2 was no significant difference between the two groups (P>0.05).Compare IMA Levels Between The Two Groups:LIRI significantly increased IMA levels at T1,T2,T3,T4 compared with To after one-lung ventilation between the two groups (P<0.05). In Group S, the peak of IMA at T4 point, and the level was higher than T1 (P<0.05).The levels of IMA at T4,T3 higher than T1 in group P (P<0.05). The levels of IMA were lower in Group S than Group P at T2,T3,T4 (P<0.05)Compare IL-6 Levels Btween The Two Groups:The levels of IL-6 have the same variation trend. At T3,T4 the levels of IL-6 were higher than To point(P<0.05);It also at T4 higher than T3 point(P<0.05); Compared with T1 and T2, the levels of IL-6 at T4 and T3 were elevated significantly (P<0.05). However, no significant difference was observed on the levels of IL-6 between two groups (P>0.05).Compare IL-10 Levels Between The Two Groups:Compared with To, the levels of IL-10 In Group S have significantly increased at T1,T2,T3,T4 (P<0.05).The level of IL-10 at T3 was higher than T, (P<0.05).The levels at T3,T4 were higher than T2 (P<0.05).In Group P, the levels of IL-10 at T1 were lower than To (P<0.05), and the level at T4 was higher than T1,T2 (P<0.05) The levels of IL-10 in Group S were significantly higher than those in Group P at T1,T2,T3,T4 point. (P<0.05)Compare TNF-a Levels Between The Two Groups:The levels of TNF-a at T1 and T2 were significantly lower than To in Group S (P <0.05). The levels of TNF-a at T3,T4 higher than T1 (P<0.05);T4,T3 compared with T2,the levels were elevated significantly (P<0.05). The level of TNF-a at T4 higher than T3 point. In Group P,at T4 the level higher than T1 (P<0.05);It also at T4 higher than T2 (P<0.05). Compared with Group P, the levels of TNF-a significantly reduced at T1,T2,T3 in Group S (P<0.05)Conclusions:1. During lobectomy, one-lung ventilation can cause lung ischemia-reperfusion injury. The serum level of IMA,TNF-a,IL-6 and IL-10 can be an important marker of the lung ischemia-reperfusion injury, and the serum level can reflect the degree of impairment of the LIRI. The degree of damage are closely related to duration of one lung ventilation.2. Sevoflurane may offer protection against one-lung ventilation induced LIRI than propofol in thoracic surgery.3. Two kinds of anesthesia methods are consistent in maintaining the stability of hemodynamics and oxygenation of the patients.