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Effect of Sevoflurane with Propofol on Stress Response during One Lung-ventilation

Author: LiRenKe
Tutor: HanXuePing
School: Zhengzhou University
Course: Anesthesiology
Keywords: Sevoflurane Propofol One-lung ventilation Cortisol Cytokines
CLC: R614
Type: Master's thesis
Year: 2009
Downloads: 21
Quote: 0
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Background and Purpose one-lung ventilation (One-lung ventilation, OLV) is widely used in thoracic surgery for surgical operation to create the ideal surgical field bleeding and severe intrapulmonary accident and emergency rescue. One-lung ventilation anesthesia can cause intrapulmonary shunt (Pulmonary shunt fraction, Qs / Qt), ventilation-perfusion ratio (Ventilation-perfusion quotientratio, V / Q) imbalance, physiological peak airway pressure increased lung ischemia - reperfusion disorders, the body to produce a very strong stress reaction, leading to a variety of stress hormones and a variety of cytokines (Cytokine, CK) release and trigger a systemic inflammatory response syndrome (Systemic inflammatory response syndrome, SIRS) in turn led to a series of pulmonary complications. Sevoflurane (sevoflurane) have some degree of inhibition on the cardiovascular system, and showed a dose-dependent trend, but its low blood gas partition coefficient (0.63) to make it easier to regulate the depth of anesthesia and to maintain hemodynamic stability the application of the one-lung ventilation with propofol compared no significant differences in the impact of hypoxic pulmonary vasoconstriction (Hypoxicplmonary vasoconstriction, HPV); myocardial ischemia and reperfusion injury have a protective effect on the brain weak vasodilator effect sevoflurane can reduce oxygen free radicals, reduce myocardial ischemia-reperfusion injury, lower lactate dehydrogenase (lactate dehydrogenase, LDH) activity, and inhibition of tumor necrosis factor-α (the Tumor narosis factor-α the release of TNF-α), the reduction of nitric oxide (nitrogenmonoxidum, NO) metabolites, reduce lung ischemia-reperfusion-induced acute lung injury (the acute lunginjury, ALI). Propofol (propofol) is widely used in clinical anesthesia and ICU (Intensive care unit) sedation of critically ill patients, there is a certain degree of inhibition on the cardiovascular system, and a dose-dependent manner; propofol on the secretion of adrenal corticosteroids. inhibition of cortisol and catecholamine concentrations can reduce, but quickly returned to preoperative levels after withdrawal; usual dose of propofol to a certain extent on the inhibition of hypoxic pulmonary vasoconstriction (HPV), increased Qs / Qt, PaO < sub> 2 decreased, but no obvious hypoxemia and carbon dioxide retention, hemodynamic stability; Propofol able to influence the generation and release of TNF-α, and at low concentrations, there will be a strong inhibitory effect, can significantly reduce the generation of interleukin -6 (Interleukin-6, IL-6), TNF-α; propofol effectively inhibit the synthesis and release of the IL-8, a slight increase of IL-4 release, increase Interleukin Su-10 (Interleukin-10, IL-10) and IL-1ra content, reducing endotoxin toxicity. Existing research results show that sevoflurane and propofol were one-lung ventilation-induced lung injury has a protective effect, but to investigate both one-lung ventilation anesthesia on hemodynamic changes and cortisol, TNF- the degree of influence of α, IL-10 has not been reported. The purpose of this study was to compare the sevoflurane inhalation combined anesthesia with propofol total intravenous anesthesia on single-lung ventilation downlink lobe resection patients with hemodynamic changes and serum cortisol, TNF-α, IL-10 impact. Evaluation of which drug is more conducive to alleviate the stress response caused by the one-lung ventilation line thoracic surgery, and to provide a theoretical basis for the clinical use of drugs. Materials and methods 30 patients lobectomy in patients with lung cancer were randomly divided into sevoflurane group (S) and propofol group (P), 15 cases each. Inclusion criteria: a week no history of infection; lung function is normal or only mild ventilatory dysfunction, immune therapy and chemotherapy before surgery were not done; immune the endocrine system complications; were not taking hormone drugs. Surgery in less than three hours, the surgery without blood transfusion input saline, Ringer's solution and colloidal solution. Exclusion criteria: (1) double-lumen tube intubation difficulties and poor positioning; (2) intraoperative corticosteroids, aprotinin or other membrane stabilizing drugs the patient, and not completed the trial. (3) blood loss greater than 400 ml or more. Preoperative preparation: included trials of patients in the 30 minutes before anesthesia, intramuscular injection of atropine 0.5mg, phenobarbital sodium 0.1g. After entering the operating room to open peripheral intravenous access, continuous monitoring of patients with Philips multifunction vital signs monitor blood pressure (BP), heart rate (HR), electrocardiogram (ECG), pulse oximetry (S P O 2 ); under local anesthesia ipsilateral upper extremity radial artery puncture directly measured arterial pressure and right subclavian venipuncture, placed in a single lumen central venous catheter to obtain blood samples induction of anesthesia intraoperative infusion, connect the bispectral index (BIS) monitor A-2000. Two sets of induction of anesthesia: are followed by intravenous injection of midazolam 0.1mg/kg, fentanyl 4μg/kg, etomidate 0.3mg/kg succinylcholine 1mg/kg after insertion of double-lumen endobronchial tube; maintenance of anesthesia: P groups using propofol micro pump intravenous infusion 4-8mg/kg · h and S group continued inhalation of 1% to 3% sevoflurane, both groups micro pump infusion of remifentanil 0.2μg/kg · min and intermittent intravenous atracurium 0.1-0.5mg/kg;, phenol infusion rate and sevoflurane concentration intraoperative propofol adjusted according to BIS values ??and hemodynamic changes. The anesthesia process of continuous monitoring of direct arterial systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate ((HR)), electrocardiogram (ECG), pulse oximetry (S P O 2 ) and end-tidal carbon dioxide partial pressure (P ET CO 2 ). Five minutes before induction (T 0 ), the lateral position lungs the ventilation TLV10 minutes (T 1 ), single lung ventilation OLV40 of minutes (T 2 < / sub>) (T 4 ), taking center venous blood specimens from serum by centrifugation OLV90 minutes (T 3 ), again the lung ventilation TLV30 minutes, with radioimmunoassay drug box in serum concentrations of cortisol (cortisol), tumor necrosis factor-α (TNF-α), human interleukin -10 quantitative enzyme-linked detection kit measured the concentration of interleukin -10 (IL-10). SPSS11.5 statistical analysis software for statistical analysis of the measurement data. Measurement data were expressed as mean ± standard deviation ((?) ± s) groups were compared using the t test for independent samples, the group used to compare a single factor analysis of variance, the rate used to compare the X 2 test criteria: P <0.05 for the difference was statistically significant. Results of the gender of the general situation of the patients were compared between the two groups of patients (P group 10 male / female 5 S group male / female), age (P group 54.5 ± 11.9 years, S group 52.13 ± 12.35 years) body weight (P group 65.8 ± 4.6 kg, S group 62.6 ± 5.7 kg), height (P group 167 ± 12.6cm s group 165 ± 13.2cm), the proportion of the the thoracotomy side of the lung (P group left / right 6 S The group left / right) to compare the difference was not statistically significant (P> 0.05) (see Schedule 1). The two groups of patients (P group 158 ± 28.6 min, S group, 156 ± 27.3 min) Maintenance of anesthesia time, surgery time (P group, 146.7 ± 25.6 min, S group, 144 ± 22.8min), single-lung ventilation time (P group 158 ± 28.6 min, S group, 156 ± 27.3 min), the amount of intraoperative transfusion (P group 1850 ± 242 ml, S group 1788 ± 321 ml), blood loss (P group 346 ± 47 ml, S group, 351 ± 43 ml) intraoperative urine output (P group 445 ± 120ml, S group, 437 ± 118 ml) between the two groups, the differences were not statistically significant (P> 0.05), atracurium dosage (P group was 104.8 ± 18.7 mg, S group 81.3 ± 16.9 mg) group asked compare the differences were statistically significant (P <0.05); sevoflurane and propofol dosage were 41.8 ± 5.2ml and 78.3 ± 4.3mg. (See Table 1) in both groups were not there intraoperative awareness; short awake time S group (9.1 ± 3.6 min) compared with the P group (12.6 ± 3.7 min); postoperative nausea and vomiting (P group 1 cases, S group The incidence of 1 case), the difference was not statistically significant (P> 0.05). (See Schedule 2) two sets of vasoactive drugs (ephedrine group 1 cases, two cases of group S, the urapidil group P 1 cases S group 1 patients, metoprolol group P 0 cases S group 1 cases, atropine P group 1 patients S group, 0 cases), the difference was not statistically significant (P> 0.05). (See Table 3). Patients intraoperative S the P O 2 and P ET CO 2 two groups were compared S P O 2 are greater than 95%,, CO , P ET 2 were maintained in between 30-40mmHg at each time point between groups, the difference was not statistically significant (P> 0.05). (See Schedule 4 and Schedule 5) between the two groups of patients at each time point, the MAP and HR changes group comparison: the two groups at each time point of blood pressure and heart rate in the normal range. SBP, DBP between the group and the group at each time point no significant difference (P> 0.05); P group T to 2 (65.2 ± 6.6 times / min), T 3 HR lower than group S T 2 (72.9 ± 7.8 times / min), T 3 (78.1 ± 7.8 times / min (69.4 ± 6.2 beats / min) ) (P <0.05); within-group comparisons: P Group 1 (68.5 ± 6.8 times / min), T 2 (65.2 ± 6.6 beats / min) Point HR below T 0 (75.4 ± 10.8 times / min) (P <0.05). Other point in time T 0 was no significant difference (P> 0.05). (See Schedule 6 and Figures 1, 2). Changes in serum cortisol concentration: comparison between groups: S group T 2 , T 3 , T-< sub> 4 (T 2 218.6 ± 12.3 ng / ml, T 3 224.7 ± 10.4 ng / ml T 4 229.5 ± 0.7ng/ml) compared with group P T 2 , T 3 the T 4 (T 2 227.7 ± 10.3 ng / ml, T 3 243.2 ± 11.5 ng / ml T 4 250.1 ± 0.8 ng / ml) were significantly lower, and the difference was statistically significant (P <0.05) group comparisons: P group T 2 , T 3 , T 4 (T 2 227.7 ± 10.3 ng / ml, T 3 243.2 ± 11.5 ng / mlT 4 250.1 ± 0.8 ng / ml) at each time point and group S T 3 T 4 (T 3 224.7 ± 10.4 ng / ml T 4 229.5 ± 0.7 ng / ml) de facto serum cortisol concentration and T 0 (P group, 212.1 ± 12.5 ng / ml, the S group 209.3 ± 9.2 ng / ml) and the difference was statistically significant (P <0.05). (See Schedule 7 and Figure 3) patients tumor necrosis factor TNF-α changes between groups at each time point comparison: between the two groups in serum concentration of TNF-α in T 3 T 4 de facto (P group T 3 0.78 ± 0.41μg/ml T 4 0.89 ± 0.35μg/ml; S group (T 3 0.62 ± 0.72μg/ml, T 4 0.74 ± 0.54μg/ml) difference was statistically significant, the S group than in the P group (P <0.05) group comparisons: P group the T 3 T 4 (T 3 0.78 ± 0.41μg/ml 4 < serum / sub> 0.89 ± 0.35μg/ml) TNF-α concentration and T , and 0 (0.48 ± 0.32μg/ml) difference was statistically significant (P <0.05), the S group within T 4 (0.74 ± 0.54μg/ml) point in time TNF-α concentration and T , 0 (0.46 ± 0.13μg/ml) difference was statistically significant ( P <0.05). (see Schedule 8 and Figure 4). interleukin -10 (IL-10), the two groups of patients at each time point, the change group comparisons: Serum levels of IL-10 concentration in each time point of difference was not statistically significant (P> 0.05). within-group comparisons: P group T 3 T 4 (T 3 75.9 ± 22.1 pg / ml, T 4 83.5 ± 17.4 pg / ml) and group S T 3 , T 4 (T 82.5 ± 17.9 pg / ml, T 4 88.4 ± 12.8 pg / ml) in the serum IL-10 concentration T 0 (P group 61.7 ± 23.2 pg / ml, S group 63.1 ± 25.4 pg / ml), the difference was statistically significant (P <0.05) (see Schedule 9 and Figure 5) Conclusion 1. sevoflurane group than the propofol group flow dynamics smooth; 2. sevoflurane than propofol has a strong ability to suppress cortisol secretion; 3. sevoflurane than propofol has strong ability to inhibit the secretion of TNF-α, sevoflurane and propionic the propofol on IL-10 did not differ significantly.

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