Xing Lingxi, Paerhati Halisa, Ding Yuyan, Zhou Yihu, Chang Jiaqi, Gu Xiaolan, Gu Lianbing
Department of Anesthesiology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, 210009, China.
BMC Anesthesiol. 2025 May 6;25(1):229. doi: 10.1186/s12871-025-03081-3.
One-lung ventilation (OLV) requires a high inspired oxygen concentration (FiO) to promote oxygenation improvement, yet it increases the risk of postoperative pulmonary complications. Therefore, this study aimed to investigate the effects of prostaglandin E (PGE) in reducing FiO during general anesthesia and mechanical ventilation on oxygenation and postoperative complications in patients undergoing OLV.
A total of 120 patients scheduled for elective left thoracotomy esophageal cancer surgery were randomly divided into four groups (n = 30): Group L (FiO = 0.4, PGE = 0.1 µg /kg), Group M (FiO = 0.5, PGE = 0.1 µg /kg), Group H (FiO = 0.6, PGE = 0.1 µg /kg), and Group C (FiO = 0.4, normal saline solution). The primary outcome was oxygenation during OLV. Secondary outcomes included intrapulmonary shunt (Qs/Qt), incidence of postoperative pulmonary complications, and changes in inflammatory cytokines.
Group H exhibited higher PaO values than Groups L, M, and C at all time points T1-T6. Group M also showed higher PaO values than Groups L and C at all time points T1-T6. In contrast, Group L demonstrated significantly higher PaO values than Group C at time points T2-T4. The nebulization groups (L, M, H) had significantly higher PaO/FiO than Group C at time points T2-T4. Group H had higher Qs/Qt values than Groups L, M, and C at all time points T1-T6. At time points T2-T4, Group L had significantly lower Qs/Qt values compared to both Group C and Group M, which in turn had significantly lower values than Group C. Regarding interleukin-6 (IL-6) levels, Group C was significantly higher than the nebulization groups at time points T5-T8, while Group L was significantly lower than Groups M and H at T8. In terms of tumor necrosis factor-α(TNF-α) levels, Group C was significantly higher than the nebulization groups at time points T7-T8. With respect to clinical pulmonary infection score (CPIS), Group L was significantly lower than Groups M, H, and C. There was no statistically significant difference in the overall incidence of postoperative complications probability (PPCs) among the four groups, nor were there statistically significant differences in pneumothorax, pulmonary infection, anastomotic leakage, ICU stay duration, or total hospital stay duration among the groups.
PGE demonstrates a significant advantage in reducing the incidence of hypoxemia, effectively improving oxygenation status in patients undergoing OLV with lower FiO. Given the effects of PGE on oxygenation and inflammatory factors, as well as the CPIS, the results of this study suggest that a clinical regimen of 0.4 FiO + 0.1 µg /kg PGE is appropriate.
Chictr.org.cn identifier: Retrospectively registered, ChiCTR1800018288(09/09/2018).
单肺通气（OLV）需要高吸入氧浓度（FiO）以促进氧合改善，但这会增加术后肺部并发症的风险。因此，本研究旨在探讨前列腺素E（PGE）在全身麻醉和机械通气期间降低FiO对接受OLV患者的氧合及术后并发症的影响。
总共120例计划行择期左胸段食管癌手术的患者被随机分为四组（n = 30）：L组（FiO = 0.4，PGE = 0.1 μg/kg）、M组（FiO = 0.5，PGE = 0.1 μg/kg）、H组（FiO = 0.6，PGE = 0.1 μg/kg）和C组（FiO = 0.4，生理盐水）。主要结局是OLV期间的氧合情况。次要结局包括肺内分流（Qs/Qt）、术后肺部并发症的发生率以及炎症细胞因子的变化。
在所有时间点T1 - T6，H组的PaO值均高于L组、M组和C组。在所有时间点T1 - T6，M组的PaO值也高于L组和C组。相比之下，在时间点T2 - T4，L组的PaO值显著高于C组。在时间点T2 - T4，雾化组（L组、M组、H组）的PaO/FiO显著高于C组。在所有时间点T1 - T6，H组的Qs/Qt值高于L组、M组和C组。在时间点T2 - T4，L组的Qs/Qt值显著低于C组和M组，而M组又显著低于C组。关于白细胞介素-6（IL-6）水平，在时间点T5 - T8，C组显著高于雾化组，而在T8时，L组显著低于M组和H组。就肿瘤坏死因子-α（TNF-α）水平而言，在时间点T7 - T8，C组显著高于雾化组。关于临床肺部感染评分（CPIS），L组显著低于M组、H组和C组。四组之间术后并发症总体发生率概率（PPCs）无统计学显著差异，各组之间气胸、肺部感染、吻合口漏、ICU住院时间或总住院时间也无统计学显著差异。
PGE在降低低氧血症发生率方面具有显著优势，能有效改善接受OLV且FiO较低患者的氧合状态。鉴于PGE对氧合和炎症因子以及CPIS的影响，本研究结果表明0.4 FiO + 0.1 μg/kg PGE的临床方案是合适的。
中国临床试验注册中心标识符：回顾性注册，ChiCTR1800018288（2018年9月9日）
