Department of Anesthesiology, The Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China.
J Healthc Eng. 2022 Apr 21;2022:7677266. doi: 10.1155/2022/7677266. eCollection 2022.
To analyze the effect of different doses of propofol on pulmonary function and inflammatory response in patients with lung ischemia reperfusion injury (LIRI) induced by one-lung ventilation (OLV) based on big data analysis.
A retrospective study was performed on 105 patients who underwent lobectomy in our hospital (January 2018 to January 2022). According to the doses of propofol, they were split into low-dose group (LDG), middle-dose group (MDG), and high-dose group (HDG), which received the continuous micropump infusion of propofol at the doses of 2 mg/(kg·h), 5 mg/(kg·h), and 10 mg/(kg·h) after induction, respectively, with 35 cases in each group. The indexes, such as the pulmonary function and inflammatory factors of patients, at different times were compared. The logistic regression analysis was performed according to the occurrence of LIRI.
With no notable difference at T0 among the three groups ( > 0.05), the Cdyn levels significantly decreased at T1 ( < 0.05) and gradually increased at T2. The Cdyn levels at T1 and T2 were remarkably higher in HDG and MDG than in LDG ( < 0.05). With no notable differences at T0 and T1 among the three groups ( > 0.05), the PO levels and RI values at T2 in MDG and HDG were lower compared with LDG ( < 0.05). The RI values at T1 and T2 in HDG were higher compared with MDG, with no obvious difference ( > 0.05). The OI levels at T1 and T2 in HDG were lower compared with the other two groups ( < 0.05), and the OI levels at T1, T2, and T3 in LDG were higher compared with MDG, with no obvious difference ( > 0.05). The TNF- and ICAM-1 levels at T1 and T2 in MDG and HDG were lower compared with LDG, with no obvious difference between MDG and HDG ( > 0.05). Compared with LDG, the MDG and HDG at T1 and T2 had lower MDA levels ( < 0.05) and higher SOD levels ( < 0.05). Logistic regression analysis showed that Cdyn, PO, and OLV time were independent risk factors for LIRI in patients undergoing lobectomy.
Propofol has a good protective effect on lung function in patients with OLV-induced LIRI. Appropriately increasing the dose of propofol can effectively improve the local cerebral hypoxia and lung compliance of patients and reduce the inflammatory response and oxidative stress response, with 5 mg/(kg·h) as the clinical reference. Preoperative assessment and preparation should be made for patients, close attention should be paid to risk factors, such as Cdyn and PO, and OLV time should be controlled.
基于大数据分析，探讨不同剂量丙泊酚对单肺通气（OLV）致肺缺血再灌注损伤（LIRI）患者肺功能和炎症反应的影响。
回顾性分析我院 2018 年 1 月至 2022 年 1 月行肺叶切除术的 105 例患者的临床资料。根据丙泊酚剂量分为低剂量组（LDG）、中剂量组（MDG）和高剂量组（HDG），诱导后分别给予丙泊酚 2mg/（kg·h）、5mg/（kg·h）、10mg/（kg·h）持续微量泵输注，每组 35 例。比较患者不同时间点的肺功能和炎症因子等指标。采用 logistic 回归分析发生 LIRI 的影响因素。
三组患者 T0 时 Cdyn 水平比较差异无统计学意义（>0.05），T1 时 Cdyn 水平显著降低（<0.05），T2 时逐渐升高。T1、T2 时 HDG 和 MDG 的 Cdyn 水平均显著高于 LDG（<0.05）。三组患者 T0、T1 时 PO 水平和 RI 值比较差异无统计学意义（>0.05），T2 时 MDG 和 HDG 的 PO 水平和 RI 值均低于 LDG（<0.05）。T1、T2 时 HDG 的 RI 值高于 MDG，但差异无统计学意义（>0.05）。T1、T2 时 HDG 的 OI 水平均低于其他两组（<0.05），T1、T2、T3 时 LDG 的 OI 水平均高于 MDG，但差异无统计学意义（>0.05）。T1、T2 时 MDG 和 HDG 的 TNF-α和 ICAM-1 水平均低于 LDG，但差异无统计学意义（>0.05）。T1、T2 时 MDG 和 HDG 的 MDA 水平均低于 LDG，SOD 水平均高于 LDG（<0.05）。logistic 回归分析显示，Cdyn、PO 和 OLV 时间是患者行肺叶切除术发生 LIRI 的独立危险因素。
丙泊酚对 OLV 致 LIRI 患者的肺功能具有良好的保护作用。适当增加丙泊酚剂量可有效改善患者局部脑缺氧和肺顺应性，降低炎症反应和氧化应激反应，以 5mg/（kg·h）为临床参考。术前应评估和准备患者，密切关注 Cdyn 和 PO 等危险因素，控制 OLV 时间。
