The Study Of Penehyclidine Hydrochloride Injection On Lung Protection In Aortic Arch Replacement

Research BackgroundAs one of the most complex and difficult heart diseases in cardiac surgery,the morbidity of aortic dissection(AD)has shown an increased and low aging tendency year by year.With the advent of an aging society,common diseases such as hypertension and diabetes in the population was gradually increasing,and similarly the morbidity of acute aortic dissection was mounting.When AD happens,elastic fibers of aortic wall are ruptured due to a variety of intrinsic and external factors,which causes an acute injury of the aortic intima and leads to its partial tears.Powerful high-speed blood flow enters into aorta through the tears of intima which is gradually stripped and peeled resulting in the formation of genuine and sham cavities between the aortic intima and tunica media.With the influx of blood,the false cavity extends lengthwise rapidly along the aorta,even to the abdominal aorta and common iliac artery,eventually leading to lethal rupture of the aortic wall.Aorta is the body's main blood vessels,undertaking the ejection pressure directly from the cardiac jitterbug,and carrying enormous blood streaming.In case the false cavity took shape,the effective blood volume decreased sharply.Without proper and timely treatment,the chance of aortic rupture was pretty high,prone to the high mortality which is up to 50-68% within 48 h,and 90% within 3 months.Studies haveshown that the incidence of postoperative acute respiratory insufficiency in patients with aortic dissection is over 13.2%.Therefore,perioperative aortic dissection has important clinical significance for the protection of the lungs.Penehyclidine hydrochloride injection is a new type of anticholinergic drug developed independently in China,which can better antagonize the function of acetylcholine,relieve the spasm of smooth muscle caused by a large amount of release of acetylcholine in the body and acute microcirculation dysfunction caused by persistent spasm of pulmonary and cerebral capillaries.Studies have shown that:Penehyclidine hydrochloride can reduce the release of cytokines after cardiopulmonary bypass for pulmonary hypertension on pediatric congenital heart patients,to protect lung function,but whether there is any effect on aortic dissection patients remains an open question.This study was to research on the effect of penehyclidine hydrochloride injection on perioperative lung protection in patients undergoing entire aortic arch replacement.PurposeTo study the effect of penehyclidine hydrochloride injection on lung protection in aortic dissection.MethodApproved by the ethics committee of the Second Affiliated Hospital of Zhengzhou University,from September 2015 to October 2017,there were 60 cases(men / women 32/28)of A-type acute aorta dissection in our hospital undergoing cardiopulmonary bypass with entire aortic arch replacement,whose age ranged from20 to 75 years,weight was from 40 to 100 kg and ASA classification was ?-?.These 60 cases were randomly divided into 2 groups of 30 cases: penehyclidine hydrochloride was given before induction of anesthesiapenehyclidine hydrochloride group(group P)and control group(Group C).After induction by conventional anesthesia visual laryngoscope assisted intubation,auscultation of double lung respiratory sound symmetry,with bilateral internal jugular vein catheterization,three positions of arterial blood pressure monitoring,and intravenous-inhalationanesthesia during surgery.In group P,penehyclidine hydrochloride 0.05 mg / kg was added during cardiopulmonary bypass,and group C was given equal volume of normal saline.3ml venous blood of the patients in two groups were taken before anesthesia(T1),before cardiopulmonary bypass(T2),1h after cardiopulmonary bypass(T3),after shutdown of cardiopulmonary bypass device(T4),4h after operation(T5)and 24 h after operation(T6),standing at room temperature for 30 min,and then 4000 rev / min centrifugation for 10 min,0.2ml serum was taken and tested by ELISA method for determination of serum tumor necrosis factor(TNF-?),interleukin-6(IL-6),interleukin-1(IL-1).At the same time,arterial blood gas was collected to calculate oxygenation index(OI).The time of breathing supported by postoperative ventilator and ICU dwell time were observed and recorded.Results1.There is no statistical significance doing intra-and inter-group comparison of patients on the general information i.e.sex ratio,age,body weight between the groups of P and C(P> 0.05).2.There was no statistical significance doing intra-and inter-group comparison on the operation time,cardiopulmonary bypass time ?the time of aortic blockage ?urine output and blood loss between the groups of P and C(P> 0.05).3.There was no significant difference in blood pressure and heart rate between the groups of P and C(P> 0.05).4.Compare with the inflammatory factors of the groups of P and C of patients at six time points4.1.Comparison of TNF-? level in serumIntra-group comparisonThe level of TNF-? in group P at T1 was not significantly different from that at T2 and T3(P> 0.05),while the level of TNF-? in group C at T1 was not significantly different from that at T2.There was statistical significance of comparing the levels of TNF-? in serum of patients at T4,T5 and T6 with T1 in group P,and comparing that at T3,T4,T5 and T6 with T1 in group C(P<0.05).Inter-group comparisonCompared with group C,there was no significant difference of TNF-? at T1,T2 and T3 in group P(all P> 0.05),while at T4,T5 and T6 it decreased(P <0.05).4.2.Comparison of IL-6 level in serumIntra-group comparisonThe level of IL-6 in both groups had no significant difference between T2 time point and T1 time point(P> 0.05).The level of IL-6 in serum of the two groups was significantly different at T3,T4,T5,T6 comparing with that at T1(P <0.05).Inter-group comparisonCompared with group C,the level of IL-6 in group P at T1,T2 and T3 was not significantly different(all P> 0.05),but it is lower than those in group C at T4,T5 and T6(P <0.05).4.3.Comparison of IL-1 level in serumIntra-group comparisonThe level of IL-1 in both groups had no significant difference between T2 time point and T1 time point(P> 0.05).Ther level of IL-1 in serum of each group had statistical significance at T3,T4,T5,T6 comparing with that at T1 time points(P<0.05).Inter-group comparisonCompared with group C,the level of IL-1 in group P at T1,T2 and T3 was not significantly different(all P> 0.05),but lower at T4,T5 and T6 than that in group C whose branching had countly momentous(P <0.05).5.Comparison of oxygenation index level(OI)Intra-group comparisonThere was no marked difference in the level of oxygenation index at T2 and T1 in each group(P> 0.05),while it was significantly different at T3,T4,T5 and T6 comparing with T1(P <0.05).Inter-group comparisonCompared with group C,there was no conspicuousness divergence in OI between group P and group C at T1,T2 and T3(all P> 0.05).The OI of group P was higher than that of group C at T4,T5 and T6(all P<0.05).6.Comparison of postoperative ventilator support time and ICU dwell time(days)Intra-group comparisonThere was no significant difference in postoperative ventilator support time and ICU residence time within each group(all P> 0.05).Inter-group comparisonCompared with group P,the postoperative ventilator support time and ICU residence time in group C was significantly longer(all P <0.05).ConclusionIn entire arch replacement,0.5mg/kg penehyclidine hydrochloride given before induction of anesthesia may be decreased the deliver of TNF-?,IL-6 and IL-1 during and after surgical operation and increase the postoperative oxygenation index,which would inhibit the inflammatory response,reduce lung ischemia-reperfusion injury,shorten the postoperative ventilator support time and ICU residence time and improve prognosis.