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Effect of Different Doses of Propofol on Pulmonary Function and Inflammatory Response in Patients with Lung Ischemia Reperfusion Injury Induced by One-Lung Ventilation Based on Big Data Analysis

Effect of Different Doses of Propofol on Pulmonary Function and Inflammatory Response in Patients... Hindawi Journal of Healthcare Engineering Volume 2022, Article ID 7677266, 7 pages https://doi.org/10.1155/2022/7677266 Research Article Effect of Different Doses of Propofol on Pulmonary Function and Inflammatory Response in Patients with Lung Ischemia Reperfusion Injury Inducedby One-LungVentilation Based onBig Data Analysis Yi Gu, Xu Liu, Tianyu Gu , and Boxiang Du Department of Anesthesiology, e Second Aliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China Correspondence should be addressed to Tianyu Gu; gutianyu@nt2191.org.cn Received 16 March 2022; Revised 31 March 2022; Accepted 9 April 2022; Published 21 April 2022 Academic Editor: Kalidoss Rajakani Copyright © 2022 Yi Gu et al.  is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To analyze the e…ect of di…erent doses of propofol on pulmonary function and in‡ammatory response in patients with lung ischemia reperfusion injury (LIRI) induced by one-lung ventilation (OLV) based on big data analysis. Methods. A ret- rospective 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.  e indexes, such as the pulmonary function and in‡ammatory factors of patients, at di…erent times were compared.  e logistic regression analysis was performed according to the occurrence of LIRI. Results. With no notable di…erence at T0 among the three groups (P > 0.05), the Cdyn levels signi›cantly decreased at T1 (P < 0.05) and gradually increased at T2.  e Cdyn levels at T1 and T2 were remarkably higher in HDG and MDG than in LDG (P < 0.05). With no notable di…erences at T0 and T1 among the three groups (P > 0.05), the P O levels and RI values at T2 in A-a 2 MDG and HDG were lower compared with LDG (P < 0.05).  e RI values at T1 and T2 in HDG were higher compared with MDG, with no obvious di…erence (P > 0.05).  e OI levels at T1 and T2 in HDG were lower compared with the other two groups (P < 0.05), and the OI levels at T1, T2, and T3 in LDG were higher compared with MDG, with no obvious di…erence (P > 0.05).  e TNF-α and ICAM-1 levels at T1 and T2 in MDG and HDG were lower compared with LDG, with no obvious di…erence between MDG and HDG (P > 0.05). Compared with LDG, the MDG and HDG at T1 and T2 had lower MDA levels (P < 0.05) and higher SOD levels (P < 0.05). Logistic regression analysis showed that Cdyn, P O , and OLV time were independent risk factors for A-a 2 LIRI in patients undergoing lobectomy. Conclusion. Propofol has a good protective e…ect on lung function in patients with OLV- induced LIRI. Appropriately increasing the dose of propofol can e…ectively improve the local cerebral hypoxia and lung compliance of patients and reduce the in‡ammatory 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 P O , and OLV time should be controlled. A-a 2 metabolites [1–3]. However, in some cases, resuming blood 1. Introduction supply after ischemia can further lead to damage and dys- Ischemia is a common pathological and physiological function of organs and tissues. Previous studies have found manifestation, and the ischemia of local tissues and organs that after a period of lung tissue ischemia, pulmonary can cause organ damage. After the blood supply is restored, vascular resistance, pulmonary capillary permeability, pul- organs and tissues can regain oxygen supply, providing monary edema, and ventilation function have been impaired necessary nutrients for metabolism and removing some and not improved during ischemia and hypoxia, while 2 Journal of Healthcare Engineering resuming blood supply will further aggravate the lung tissue with abnormal coagulation function, (7) patients who took damage [4, 5]. According to clinical investigation and sta- sedative drugs for a long time, and (8) patients who received preoperative radiotherapy and chemotherapy. tistics, lung ischemia reperfusion injury (LIRI) is still the most common complication after thoracic surgeries, such as lobectomy, cardiopulmonary bypass, and lung transplan- 2.4. Methods. Before surgery, water and food were forbid- tation [6, 7]. *erefore, the related mechanism and effective den. After entering the room, the peripheral venous access of preventive measures of LIRI are still attracting much at- the upper limb was opened, the blood pressure, ECG, and tention. One-lung ventilation (OLV) is the preferred ven- oxygen saturation of the patients were routinely monitored, tilation method in lobectomy and creates a favorable and the bispectral index (BIS) was measured by connecting therapeutic environment for the ipsilateral lung by isolating the bispectral index monitor for anesthesia induction [12]. the ipsilateral lung, keeping the airway unobstructed and *e double-lumen endobronchial tube was used for intu- preventing cross-infection. However, OLV can increase bation, positioned under direct vision with a fiber bron- intrapulmonary shunt and airway resistance, affect alveolar choscope, and fixed. Mechanical ventilation was performed oxygenation function, and lung tissue compliance, and then, with the ventilation parameters, including tidal volume as it can lead to LIRI, threatening the life of patients and af- 8–10 ml/kg, ventilation frequency as 10–12 times/min, re- fecting postoperative recovery [8, 9]. Propofol, a common spiratory ratio as 1 : 2, oxygen saturation as 95–100%, and clinical anesthetic, is an emulsion with strong lipophilicity, partial pressure end-tidal carbon dioxide (PETCO ) as commonly used in clinic, which is easy to accumulate on the 32–45 mmHg. As for the maintenance of anesthesia, LDG, lipid bilayer of cells to form a protective membrane and MDG, and HDG received the continuous micropump in- improve the resistance to oxidation [10]. In addition, pro- fusion of propofol at the doses of 2 mg/(kg·h), 5 mg/(kg·h), pofol can affect a variety of inflammatory reactions, with the and 10 mg/(kg·h) after induction, respectively. Attention was effects of preventing oxygen free radicals and lipid perox- paid to the depth of anesthesia. According to the actual idation and reducing inflammatory reactions. Based on this, blood pressure and pulse, 1.0–2.0 μg/kg of fentanyl was the paper aimed to investigate the effect of different doses of intermittently dripped to maintain the oxygen saturation propofol on the pulmonary function and inflammatory above 94%, with the intravenous injection of 1.0 mg/(kg·h) response in patients with OLV-induced LIRI through rel- of rocuronium bromide after an interval of 30 min to evant data analysis. maintain muscle relaxation until chest closure. *e BIS value of anesthesia depth was 40–60 during surgery. 2. Materials and Methods 2.1. Patient Screening and Grouping. A retrospective study 2.5. Observation Indexes. General data. *e baseline data, was performed on 105 patients who underwent lobectomy in such as age, BMI, OLV time, anesthesia time, gender, ASA our hospital (January 2018 to January 2022). According to classification, smoking history, and drinking history were the doses of propofol, they were split into low-dose group recorded and analyzed. (LDG), middle-dose group (MDG), and high-dose group Pulmonary function. According to the tidal volume (HDG), which received the continuous micropump infusion (VT), respiratory peak (Pmax), and positive end expiratory of propofol at the doses of 2 mg/(kg·h), 5 mg/(kg·h), and pressure (PEEP) of patients, the lung dynamic compliance 10 mg/(kg·h) after induction, respectively, with 35 cases in (Cdyn) was calculated. Cdyn � VT/(Pmax-PEEP). After 1 ml each group. *is study conformed to the ethics and morality of radial artery blood was collected, blood gas analysis was of our hospital, and the research program was in accordance performed with a blood gas analyzer (model: ABL800; with the Declaration of Helsinki (2013) [11]. manufacturer: Radiometer, Denmark). Alveolar-arterial oxygen difference (P O ) � 713 × FiO -1.25 × PaCO - A-a 2 2 2 PaO , respiratory index (RI) � P O /PaO , oxygenation 2 A-a 2 2 2.2. Inclusion Criteria. Inclusion criteria were as follows: (1) index (OI) � P O /FiO , FiO � fraction of inspired oxy- A-a 2 2 2 all patients who were diagnosed with early lung cancer by gen, PaCO � arterial partial pressure of carbon dioxide, and pathological examination, (2) patients had no cognitive PaO � arterial partial pressure of oxygen. dysfunction, (3) patients met the indications of lobectomy, Inflammatory factor levels. Peripheral venous blood was (4) there was no abnormality in the routine examination of extracted under the fasting state, and the supernatant was the heart and liver function before surgery, and (5) patients collected after centrifugation. *e levels of inflammatory had complete clinical data. *ey and their families knew and factors, such as the tumor necrosis factor-α (TNF-α) and agreed to this study, and they signed the consent form for intercellular adhesion molecule-1 (ICAM-1), were detected surgery and anesthesia. by enzyme linked immunosorbent assay (ELISA). Oxidative stress response. Peripheral venous blood was 2.3. Exclusion Criteria. Exclusion criteria were as follows: (1) extracted under the fasting state, and the supernatant was patients with dysfunction in organs, such as the heart, liver, collected after centrifugation. *e superoxide dismutase and kidney, (2) patients with a history of surgical treatment, (SOD) level was detected by ELISA, and the malondialde- (3) patients with surgical intolerance, (4) patients with in- hyde (MDA) was detected by thiobarbituric acid. All ELISA fectious diseases, mental illnesses, and other malignant tu- test kits were purchased from Shanghai Enzyme-linked mors, (5) patients with unstable hemodynamics, (6) patients Biotechnology Co., Ltd. Journal of Healthcare Engineering 3 *e above indicators were observed before anesthesia 3.3. Inflammatory Factor Levels. No obvious difference was induction (T0), 15 min after OLV (T1), and 15 min after two- observed in the TNF-α and ICAM-1 levels at T0 among the lung ventilation (T2). Logistic regression analysis was per- three groups (P> 0.05). *e TNF-α and ICAM-1 levels at T1 formed according to the occurrence of LIRI in patients and T2 in MDG and HDG were lower compared with LDG, undergoing lobectomy admitted to our hospital (January with no obvious difference between MDG and HDG 2018 to January 2022), aiming to analyze the independent (P> 0.05), as listed in Table 5. risk factors for LIRI after OLV. 3.4. Oxidative Stress Response. *e MDA levels in the three 2.6. Statistical Processing. *e data were processed by groups increased gradually from T0 to T2, and the levels at software SPSS22.0 and graphed by GraphPad Prism 7 T1 and T2 in MDG and HDG were markedly lower com- (GraphPad Software, San Diego, USA). *e enumeration pared with LDG (P< 0.05). *e SOD levels in the three and measurement data were expressed as [n (%)] and (x± s) groups decreased gradually from T0 to T2, and the levels at and tested by X and t test. *e differences were statistically T1 and T2 in MDG and HDG were markedly higher significant at P< 0.05. compared with LDG (P< 0.05) (see Table 6). 3. Results 3.5. Logistic Regression Data Analysis. Logistic regression analysis was performed on the clinical data of some OLV 3.1. General Data. No statistical difference was observed in patients admitted to our hospital who underwent lobectomy. general data, such as age, BMI, OLV time, anesthesia time, Table 7 demonstrates that Cdyn, P O , and OLV time were A-a 2 gender, ASA classification, smoking history, and drinking independent risk factors for LIRI in patients undergoing history among the three groups (P> 0.05) (see Table 1). lobectomy. ASA classification refers to the American Society of Anesthesiologists (ASA) classification, which classified the patients according to their physical conditions and surgical 4. Discussion risks. Grade I indicated that the patients were healthy and had OLV, a widely used ventilation technique in thoracic sur- good nutrition and normal function of all organs, with the gery, has become a necessary condition for thoracoscopic perioperative mortality rate of 0.06%–0.08%. Grade II indi- surgery, and it provides a prerequisite for the development cated that the patients had mild coexisting diseases in addition of thoracoscopic and laparoscopic surgery [13–15]. As a to the surgical disease and sound functional compensation, nonphysiological ventilation mode, OLV can lead to in- with the perioperative mortality rate of 0.27%–0.40%. creased airway resistance, decreased lung compliance, im- paired ventilation function, and hypoxemia, further 3.2. Lung Function aggravating lung injury. After ventilation is restored, the reperfusion of the ischemic area in the affected lung leads to 3.2.1. Lung Dynamic Compliance. With no notable differ- inflammatory stress response and oxidative stress injury. ence at T0 among the three groups (P> 0.05), the Cdyn Related studies have pointed out that LIRI is a manifestation levels significantly decreased at T1 (P< 0.05) and gradually of systemic inflammatory diseases, which may be related to increased at T2. *e Cdyn levels at T1 and T2 were re- the generation of free radicals, release of cytokines, apoptosis markably higher in HDG and MDG than in LDG (P< 0.05), of lung epithelial cells, and aggregation of neutrophils in the as presented in Figure 1. lungs, however, the specific mechanism remains unclear [16, 17]. In recent years, with the development of anesthesia medicine, studies have found that the use of anesthetics has a 3.2.2. P O . *e P O levels gradually increased from T0 A-a 2 A-a 2 to T2 in the three groups. With no notable differences at T0 certain impact on the occurrence of perioperative compli- and T1 among the three groups (P> 0.05), the P cations. Numerous studies have shown that propofol, as a O level at A-a 2 T2 in MDG and HDG was lower compared with LDG new type of phenolic anesthetics, has a certain protective (P< 0.05), as detailed in Table 2. effect on an ischemia reperfusion injury. Related animal experiments show that propofol can not only affect a variety of cytokines and pathways of the inflammatory response but 3.2.3. RI. With no notable differences at T0 and T1 among also has the effects of preventing oxygen free radicals and the three groups, the RI value at T2 in MDG and HDG was lipid peroxidation, reducing inflammatory reactions [18, 19]. lower compared with LDG (P< 0.05). *e RI values at T1 However, there are few studies on the correlation of the and T2 in HDG were higher compared with MDG, with no protective mechanism for the lungs with the dosage of obvious difference (P> 0.05) (see Table 3). propofol. *erefore, the research tried to investigate the protective effects of propofol on the lung function in patients 3.2.4. OI. *e OI levels at T1 and T2 in HDG were lower with OLV-induced LIRI and investigate its relationship with compared with the other two groups (P< 0.05), and the OI the dosage. levels at T1, T2, and T3 in LDG were higher compared with Cdyn is a crucial index for assessing the elasticity of lung MDG, with no obvious difference (P> 0.05), as detailed in tissues and respiratory function. *e Cdyn level will decrease Table 4. during OLV, however, too low Cdyn level can cause 4 Journal of Healthcare Engineering Table 1: Comparison of general data (n � 35). Observation indexes LDG MDG HDG P Age (yrs) 64.16± 5.08 63.47± 4.62 63.88± 4.70 >0.05 BMI (kg/m ) 24.78± 1.14 24.80± 1.16 24.68± 1.12 >0.05 OLV time (min) 142.61± 20.19 143.05± 20.43 142.70± 20.51 >0.05 Anaesthesia time (min) 164.29± 22.95 164.83± 23.61 165.02± 23.74 >0.05 Gender Male 19 (54.29) 21 (60.00) 22 (62.86) >0.05 Female 16 (45.71) 14 (40.00) 13 (37.14) ASA classification I 18 (51.43) 19 (54.29) 18 (51.43) >0.05 II 17 (48.57) 16 (45.71) 17 (48.57) Smoking history 13 (37.14) 10 (28.57) 11 (31.43) >0.05 Drinking history 17 (48.57) 16 (45.71) 17 (48.57) >0.05 Notes: BMI refers to the body mass index, which is an internationally common index to determine the degree of fatness and thinness of a person and whether the person was healthy. BMI � weight (kg)÷ height (m) . 110 higher compared with MDG, with no obvious difference (P> 0.05). *e OI levels at T1 and T2 in HDG were re- markably lower compared with the other two groups (P< 0.05), and the OI levels at T1, T2, and T3 in LDG were ** ** * 80 higher compared with MDG, with no obvious difference (P> 0.05). P O and RI can reflect the pulmonary diffusion A-a 2 function of patients and objectively reflect the lung function and degree of lung injury. Higher P O and RI levels A-a 2 suggest more serious lung injury and worse lung function. T0 T1 T2 OI reflects oxygenation function. During OLV, the blood flowing through the collapsed lung fails to be oxygenated in Low dose group time, resulting in mixed venous blood after returning to the Medium dose group left heart and leading to hypoxemia. At this time, the body High dose group will initiate the mechanism of hypoxic pulmonary vaso- Figure 1: Cdyn levels (x± s). Note. *e abscissa represented the constriction to reduce the intrapulmonary shunt under time points, and the ordinate represented the detection level (ml/ hypoxia and protect the lung function [22–24]. *e study cmH O). *e Cdyn levels at T0, T1, and T2 in LDG were revealed that the appropriate increase in propofol dosage can (92.47± 12.19), (65.70± 9.25), and (70.16± 8.52). *e Cdyn levels at improve the diffusion of oxygen in the lungs and reduce the T0, T1, and T2 in MDG were (92.51± 12.25), (78.59± 9.41), and inhibitory effect of OLV on oxygenation, but excessive (85.05± 8.31). *e Cdyn levels at T0, T1, and T2 in HDG were propofol can also increase the risk of hypoxemia in patients. (92.73± 12.14), (82.22± 9.03), and (87.28± 8.40). from left to In addition, the abnormal release of inflammatory media- right represented notable differences in the Cdyn levels at T1 and ∗∗ tors, such as cytokines, is an important link in LIRI. In- T2 between LDG and MDG (t � 5.779, 7.401; P< 0.001). from left to right represented notable differences in the Cdyn levels at T1 flammatory mediators, such as TNF-α and ICAM-1, can and T2 between LDG and HDG (t � 7.501, 8.465; P< 0.001). increase the permeability of blood vessels, make the intra- vascular fluid and even red blood cells extravasate to form pulmonary interstitial edema, affect gas exchange, reduce the postoperative pulmonary edema [20, 21]. In this study, with secretion of pulmonary surfactant, and reduce the partial no notable difference at T0 among the three groups pressure of blood oxygen. SOD and MDA are significant (P> 0.05), the Cdyn levels significantly decreased at T1 indicators reflecting oxidation and antioxidant status in the (P< 0.05) and gradually increased at T2. *e Cdyn levels at body, in which the SOD level can reflect the ability of the body to scavenge free radicals, while MDA, a product of lipid T1 and T2 were remarkably higher in HDG and MDG than LDG (P< 0.05). *ey indicated that propofol can improve peroxidation, indirectly reflects the degree of tissue damage resulting from oxygen free radicals. In this research, no the lung compliance of patients, and the improvement effect gets more obvious with the increase of dosage, however, obvious difference was observed in the TNF-α and ICAM-1 there is no obvious difference in the improvement effect levels at T0 among the three groups (P> 0.05). *e TNF-α between propofol at 10 mg/(kg·h) and that at 5 mg/(kg·h). and ICAM-1 levels at T1 and T2 in MDG and HDG were *e P O levels gradually increased from T0 to T2 in the markedly lower compared with LDG, with no obvious A-a 2 three groups. With no notable differences at T0 and T1 difference between MDG and HDG (P> 0.05). *e results among the three groups (P> 0.05), the P O levels and RI were similar to the research of Yabuki et al. [25]. *e MDA A-a 2 values at T2 in MDG and HDG were lower compared with levels in the three groups increased gradually from T0 to T2, LDG (P< 0.05). *e RI values at T1 and T2 in HDG were and the levels at T1 and T2 in MDG and HDG were ml (cmH2O) Journal of Healthcare Engineering 5 Table 2: P O levels of patients (mmHg). A-a 2 Group T0 T1 T2 LDG 19.35± 2.06 25.16± 2.01 30.15± 4.28 MDG 19.38± 2.10 22.83± 2.14 24.15± 3.19 HDG 19.33± 2.08 23.95± 2.06 24.06± 3.15 Note: represented notable differences when compared with LDG (P< 0.05). Table 3: RI values of patients (x± s). Group T0 T1 T2 LDG 0.46± 0.15 0.69± 0.15 0.71± 0.15 MDG 0.49± 0.14 0.48± 0.13 0.52± 0.11 HDG 0.47± 0.13 0.51± 0.13 0.56± 0.12 Table 4: OI levels (mmHg). Group T0 T1 T2 ∗ ∗ LDG 445.10± 26.39 390.21± 18.50 370.25± 14.10 ∗ ∗ MDG 439.51± 25.77 385.37± 16.15 368.22± 14.82 HDG 448.63± 26.71 375.15± 25.20 330.42± 17.13 Note: represented notable differences when compared with HDG (P< 0.05). Table 5: Inflammatory factor levels of patients (x± s). TNF-α (ng/ml) Group T0 T1 T2 LDG 12.75± 2.04 25.33± 3.46 30.11± 3.29 ∗ ∗ MDG 12.71± 2.06 17.08± 2.05 18.50± 2.12 ∗∗ ∗∗ HDG 12.80± 2.10 16.97± 1.88 17.64± 2.07 ICAM-1 (pg/ml) Group T0 T1 T2 LDG 155.43± 19.27 260.72± 31.56 305.49± 40.35 ∗ ∗ MDG 155.28± 20.04 211.62± 31.25 235.09± 31.20 ∗∗ ∗∗ HDG 155.89± 20.10 203.50± 30.17 227.37± 31.04 ∗ ∗∗ Note: represented an obvious difference between MDG and LDG (P< 0.05). represented an obvious difference between HDG and LDG (P< 0.05). markedly higher compared with LDG (P< 0.05). *e results Table 6: Oxidative stress response of patients (x± s). further confirmed that increasing the dosage of propofol MDA (mmol/L) effectively reduces the inflammatory response and improves Group T0 T1 T2 oxidative stress, with a strong ability to scavenge free rad- LDG 4.61± 0.52 6.03± 0.78 10.35± 0.92 icals. *e above results suggest that the optimal dosage of ∗ ∗ MDG 4.58± 0.60 5.58± 0.49 8.12± 0.89 propofol should be selected in clinical practice according to ∗∗ ∗∗ HDG 4.63± 0.57 5.10± 0.41 7.88± 0.76 the actual treatment needs of patients combined with in- SOD (U/L) dicators such as physical fitness and body status, which can Group T0 T1 T2 be appropriately increased on the basis of 5 mg/(kg·h) but LDG 73.75± 7.83 64.73± 6.24 57.29± 7.14 not exceeding 10 mg/(kg·h). Logistic regression analysis was ∗ ∗ MDG 73.80± 7.91 69.64± 7.02 67.08± 6.19 performed on the clinical data of some OLV patients ad- ∗∗ ∗∗ HDG 73.71± 7.85 70.05± 6.95 67.42± 6.03 mitted to our hospital who underwent lobectomy. It was Note: represented an obvious difference between MDG and LDG found that Cdyn, P O , and OLV time were independent A-a 2 ∗∗ (P< 0.05). represented an obvious difference between HDG and LDG risk factors for LIRI in patients undergoing lobectomy. It is (P< 0.05). suggested that preoperative assessment and preparation should be made for patients, close attention should be paid markedly lower compared with LDG (P< 0.05). *e SOD to the changes in indicators such as Cdyn and P O , and A-a 2 levels in the three groups decreased gradually from T0 to T2, OLV time should be controlled as much as possible during and the levels at T1 and T2 in MDG and HDG were surgery. *e deficiencies of this study are as follows. 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Effect of Different Doses of Propofol on Pulmonary Function and Inflammatory Response in Patients with Lung Ischemia Reperfusion Injury Induced by One-Lung Ventilation Based on Big Data Analysis

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Copyright © 2022 Yi Gu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Hindawi Journal of Healthcare Engineering Volume 2022, Article ID 7677266, 7 pages https://doi.org/10.1155/2022/7677266 Research Article Effect of Different Doses of Propofol on Pulmonary Function and Inflammatory Response in Patients with Lung Ischemia Reperfusion Injury Inducedby One-LungVentilation Based onBig Data Analysis Yi Gu, Xu Liu, Tianyu Gu , and Boxiang Du Department of Anesthesiology, e Second Aliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China Correspondence should be addressed to Tianyu Gu; gutianyu@nt2191.org.cn Received 16 March 2022; Revised 31 March 2022; Accepted 9 April 2022; Published 21 April 2022 Academic Editor: Kalidoss Rajakani Copyright © 2022 Yi Gu et al.  is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To analyze the e…ect of di…erent doses of propofol on pulmonary function and in‡ammatory response in patients with lung ischemia reperfusion injury (LIRI) induced by one-lung ventilation (OLV) based on big data analysis. Methods. A ret- rospective 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.  e indexes, such as the pulmonary function and in‡ammatory factors of patients, at di…erent times were compared.  e logistic regression analysis was performed according to the occurrence of LIRI. Results. With no notable di…erence at T0 among the three groups (P > 0.05), the Cdyn levels signi›cantly decreased at T1 (P < 0.05) and gradually increased at T2.  e Cdyn levels at T1 and T2 were remarkably higher in HDG and MDG than in LDG (P < 0.05). With no notable di…erences at T0 and T1 among the three groups (P > 0.05), the P O levels and RI values at T2 in A-a 2 MDG and HDG were lower compared with LDG (P < 0.05).  e RI values at T1 and T2 in HDG were higher compared with MDG, with no obvious di…erence (P > 0.05).  e OI levels at T1 and T2 in HDG were lower compared with the other two groups (P < 0.05), and the OI levels at T1, T2, and T3 in LDG were higher compared with MDG, with no obvious di…erence (P > 0.05).  e TNF-α and ICAM-1 levels at T1 and T2 in MDG and HDG were lower compared with LDG, with no obvious di…erence between MDG and HDG (P > 0.05). Compared with LDG, the MDG and HDG at T1 and T2 had lower MDA levels (P < 0.05) and higher SOD levels (P < 0.05). Logistic regression analysis showed that Cdyn, P O , and OLV time were independent risk factors for A-a 2 LIRI in patients undergoing lobectomy. Conclusion. Propofol has a good protective e…ect on lung function in patients with OLV- induced LIRI. Appropriately increasing the dose of propofol can e…ectively improve the local cerebral hypoxia and lung compliance of patients and reduce the in‡ammatory 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 P O , and OLV time should be controlled. A-a 2 metabolites [1–3]. However, in some cases, resuming blood 1. Introduction supply after ischemia can further lead to damage and dys- Ischemia is a common pathological and physiological function of organs and tissues. Previous studies have found manifestation, and the ischemia of local tissues and organs that after a period of lung tissue ischemia, pulmonary can cause organ damage. After the blood supply is restored, vascular resistance, pulmonary capillary permeability, pul- organs and tissues can regain oxygen supply, providing monary edema, and ventilation function have been impaired necessary nutrients for metabolism and removing some and not improved during ischemia and hypoxia, while 2 Journal of Healthcare Engineering resuming blood supply will further aggravate the lung tissue with abnormal coagulation function, (7) patients who took damage [4, 5]. According to clinical investigation and sta- sedative drugs for a long time, and (8) patients who received preoperative radiotherapy and chemotherapy. tistics, lung ischemia reperfusion injury (LIRI) is still the most common complication after thoracic surgeries, such as lobectomy, cardiopulmonary bypass, and lung transplan- 2.4. Methods. Before surgery, water and food were forbid- tation [6, 7]. *erefore, the related mechanism and effective den. After entering the room, the peripheral venous access of preventive measures of LIRI are still attracting much at- the upper limb was opened, the blood pressure, ECG, and tention. One-lung ventilation (OLV) is the preferred ven- oxygen saturation of the patients were routinely monitored, tilation method in lobectomy and creates a favorable and the bispectral index (BIS) was measured by connecting therapeutic environment for the ipsilateral lung by isolating the bispectral index monitor for anesthesia induction [12]. the ipsilateral lung, keeping the airway unobstructed and *e double-lumen endobronchial tube was used for intu- preventing cross-infection. However, OLV can increase bation, positioned under direct vision with a fiber bron- intrapulmonary shunt and airway resistance, affect alveolar choscope, and fixed. Mechanical ventilation was performed oxygenation function, and lung tissue compliance, and then, with the ventilation parameters, including tidal volume as it can lead to LIRI, threatening the life of patients and af- 8–10 ml/kg, ventilation frequency as 10–12 times/min, re- fecting postoperative recovery [8, 9]. Propofol, a common spiratory ratio as 1 : 2, oxygen saturation as 95–100%, and clinical anesthetic, is an emulsion with strong lipophilicity, partial pressure end-tidal carbon dioxide (PETCO ) as commonly used in clinic, which is easy to accumulate on the 32–45 mmHg. As for the maintenance of anesthesia, LDG, lipid bilayer of cells to form a protective membrane and MDG, and HDG received the continuous micropump in- improve the resistance to oxidation [10]. In addition, pro- fusion of propofol at the doses of 2 mg/(kg·h), 5 mg/(kg·h), pofol can affect a variety of inflammatory reactions, with the and 10 mg/(kg·h) after induction, respectively. Attention was effects of preventing oxygen free radicals and lipid perox- paid to the depth of anesthesia. According to the actual idation and reducing inflammatory reactions. Based on this, blood pressure and pulse, 1.0–2.0 μg/kg of fentanyl was the paper aimed to investigate the effect of different doses of intermittently dripped to maintain the oxygen saturation propofol on the pulmonary function and inflammatory above 94%, with the intravenous injection of 1.0 mg/(kg·h) response in patients with OLV-induced LIRI through rel- of rocuronium bromide after an interval of 30 min to evant data analysis. maintain muscle relaxation until chest closure. *e BIS value of anesthesia depth was 40–60 during surgery. 2. Materials and Methods 2.1. Patient Screening and Grouping. A retrospective study 2.5. Observation Indexes. General data. *e baseline data, was performed on 105 patients who underwent lobectomy in such as age, BMI, OLV time, anesthesia time, gender, ASA our hospital (January 2018 to January 2022). According to classification, smoking history, and drinking history were the doses of propofol, they were split into low-dose group recorded and analyzed. (LDG), middle-dose group (MDG), and high-dose group Pulmonary function. According to the tidal volume (HDG), which received the continuous micropump infusion (VT), respiratory peak (Pmax), and positive end expiratory of propofol at the doses of 2 mg/(kg·h), 5 mg/(kg·h), and pressure (PEEP) of patients, the lung dynamic compliance 10 mg/(kg·h) after induction, respectively, with 35 cases in (Cdyn) was calculated. Cdyn � VT/(Pmax-PEEP). After 1 ml each group. *is study conformed to the ethics and morality of radial artery blood was collected, blood gas analysis was of our hospital, and the research program was in accordance performed with a blood gas analyzer (model: ABL800; with the Declaration of Helsinki (2013) [11]. manufacturer: Radiometer, Denmark). Alveolar-arterial oxygen difference (P O ) � 713 × FiO -1.25 × PaCO - A-a 2 2 2 PaO , respiratory index (RI) � P O /PaO , oxygenation 2 A-a 2 2 2.2. Inclusion Criteria. Inclusion criteria were as follows: (1) index (OI) � P O /FiO , FiO � fraction of inspired oxy- A-a 2 2 2 all patients who were diagnosed with early lung cancer by gen, PaCO � arterial partial pressure of carbon dioxide, and pathological examination, (2) patients had no cognitive PaO � arterial partial pressure of oxygen. dysfunction, (3) patients met the indications of lobectomy, Inflammatory factor levels. Peripheral venous blood was (4) there was no abnormality in the routine examination of extracted under the fasting state, and the supernatant was the heart and liver function before surgery, and (5) patients collected after centrifugation. *e levels of inflammatory had complete clinical data. *ey and their families knew and factors, such as the tumor necrosis factor-α (TNF-α) and agreed to this study, and they signed the consent form for intercellular adhesion molecule-1 (ICAM-1), were detected surgery and anesthesia. by enzyme linked immunosorbent assay (ELISA). Oxidative stress response. Peripheral venous blood was 2.3. Exclusion Criteria. Exclusion criteria were as follows: (1) extracted under the fasting state, and the supernatant was patients with dysfunction in organs, such as the heart, liver, collected after centrifugation. *e superoxide dismutase and kidney, (2) patients with a history of surgical treatment, (SOD) level was detected by ELISA, and the malondialde- (3) patients with surgical intolerance, (4) patients with in- hyde (MDA) was detected by thiobarbituric acid. All ELISA fectious diseases, mental illnesses, and other malignant tu- test kits were purchased from Shanghai Enzyme-linked mors, (5) patients with unstable hemodynamics, (6) patients Biotechnology Co., Ltd. Journal of Healthcare Engineering 3 *e above indicators were observed before anesthesia 3.3. Inflammatory Factor Levels. No obvious difference was induction (T0), 15 min after OLV (T1), and 15 min after two- observed in the TNF-α and ICAM-1 levels at T0 among the lung ventilation (T2). Logistic regression analysis was per- three groups (P> 0.05). *e TNF-α and ICAM-1 levels at T1 formed according to the occurrence of LIRI in patients and T2 in MDG and HDG were lower compared with LDG, undergoing lobectomy admitted to our hospital (January with no obvious difference between MDG and HDG 2018 to January 2022), aiming to analyze the independent (P> 0.05), as listed in Table 5. risk factors for LIRI after OLV. 3.4. Oxidative Stress Response. *e MDA levels in the three 2.6. Statistical Processing. *e data were processed by groups increased gradually from T0 to T2, and the levels at software SPSS22.0 and graphed by GraphPad Prism 7 T1 and T2 in MDG and HDG were markedly lower com- (GraphPad Software, San Diego, USA). *e enumeration pared with LDG (P< 0.05). *e SOD levels in the three and measurement data were expressed as [n (%)] and (x± s) groups decreased gradually from T0 to T2, and the levels at and tested by X and t test. *e differences were statistically T1 and T2 in MDG and HDG were markedly higher significant at P< 0.05. compared with LDG (P< 0.05) (see Table 6). 3. Results 3.5. Logistic Regression Data Analysis. Logistic regression analysis was performed on the clinical data of some OLV 3.1. General Data. No statistical difference was observed in patients admitted to our hospital who underwent lobectomy. general data, such as age, BMI, OLV time, anesthesia time, Table 7 demonstrates that Cdyn, P O , and OLV time were A-a 2 gender, ASA classification, smoking history, and drinking independent risk factors for LIRI in patients undergoing history among the three groups (P> 0.05) (see Table 1). lobectomy. ASA classification refers to the American Society of Anesthesiologists (ASA) classification, which classified the patients according to their physical conditions and surgical 4. Discussion risks. Grade I indicated that the patients were healthy and had OLV, a widely used ventilation technique in thoracic sur- good nutrition and normal function of all organs, with the gery, has become a necessary condition for thoracoscopic perioperative mortality rate of 0.06%–0.08%. Grade II indi- surgery, and it provides a prerequisite for the development cated that the patients had mild coexisting diseases in addition of thoracoscopic and laparoscopic surgery [13–15]. As a to the surgical disease and sound functional compensation, nonphysiological ventilation mode, OLV can lead to in- with the perioperative mortality rate of 0.27%–0.40%. creased airway resistance, decreased lung compliance, im- paired ventilation function, and hypoxemia, further 3.2. Lung Function aggravating lung injury. After ventilation is restored, the reperfusion of the ischemic area in the affected lung leads to 3.2.1. Lung Dynamic Compliance. With no notable differ- inflammatory stress response and oxidative stress injury. ence at T0 among the three groups (P> 0.05), the Cdyn Related studies have pointed out that LIRI is a manifestation levels significantly decreased at T1 (P< 0.05) and gradually of systemic inflammatory diseases, which may be related to increased at T2. *e Cdyn levels at T1 and T2 were re- the generation of free radicals, release of cytokines, apoptosis markably higher in HDG and MDG than in LDG (P< 0.05), of lung epithelial cells, and aggregation of neutrophils in the as presented in Figure 1. lungs, however, the specific mechanism remains unclear [16, 17]. In recent years, with the development of anesthesia medicine, studies have found that the use of anesthetics has a 3.2.2. P O . *e P O levels gradually increased from T0 A-a 2 A-a 2 to T2 in the three groups. With no notable differences at T0 certain impact on the occurrence of perioperative compli- and T1 among the three groups (P> 0.05), the P cations. Numerous studies have shown that propofol, as a O level at A-a 2 T2 in MDG and HDG was lower compared with LDG new type of phenolic anesthetics, has a certain protective (P< 0.05), as detailed in Table 2. effect on an ischemia reperfusion injury. Related animal experiments show that propofol can not only affect a variety of cytokines and pathways of the inflammatory response but 3.2.3. RI. With no notable differences at T0 and T1 among also has the effects of preventing oxygen free radicals and the three groups, the RI value at T2 in MDG and HDG was lipid peroxidation, reducing inflammatory reactions [18, 19]. lower compared with LDG (P< 0.05). *e RI values at T1 However, there are few studies on the correlation of the and T2 in HDG were higher compared with MDG, with no protective mechanism for the lungs with the dosage of obvious difference (P> 0.05) (see Table 3). propofol. *erefore, the research tried to investigate the protective effects of propofol on the lung function in patients 3.2.4. OI. *e OI levels at T1 and T2 in HDG were lower with OLV-induced LIRI and investigate its relationship with compared with the other two groups (P< 0.05), and the OI the dosage. levels at T1, T2, and T3 in LDG were higher compared with Cdyn is a crucial index for assessing the elasticity of lung MDG, with no obvious difference (P> 0.05), as detailed in tissues and respiratory function. *e Cdyn level will decrease Table 4. during OLV, however, too low Cdyn level can cause 4 Journal of Healthcare Engineering Table 1: Comparison of general data (n � 35). Observation indexes LDG MDG HDG P Age (yrs) 64.16± 5.08 63.47± 4.62 63.88± 4.70 >0.05 BMI (kg/m ) 24.78± 1.14 24.80± 1.16 24.68± 1.12 >0.05 OLV time (min) 142.61± 20.19 143.05± 20.43 142.70± 20.51 >0.05 Anaesthesia time (min) 164.29± 22.95 164.83± 23.61 165.02± 23.74 >0.05 Gender Male 19 (54.29) 21 (60.00) 22 (62.86) >0.05 Female 16 (45.71) 14 (40.00) 13 (37.14) ASA classification I 18 (51.43) 19 (54.29) 18 (51.43) >0.05 II 17 (48.57) 16 (45.71) 17 (48.57) Smoking history 13 (37.14) 10 (28.57) 11 (31.43) >0.05 Drinking history 17 (48.57) 16 (45.71) 17 (48.57) >0.05 Notes: BMI refers to the body mass index, which is an internationally common index to determine the degree of fatness and thinness of a person and whether the person was healthy. BMI � weight (kg)÷ height (m) . 110 higher compared with MDG, with no obvious difference (P> 0.05). *e OI levels at T1 and T2 in HDG were re- markably lower compared with the other two groups (P< 0.05), and the OI levels at T1, T2, and T3 in LDG were ** ** * 80 higher compared with MDG, with no obvious difference (P> 0.05). P O and RI can reflect the pulmonary diffusion A-a 2 function of patients and objectively reflect the lung function and degree of lung injury. Higher P O and RI levels A-a 2 suggest more serious lung injury and worse lung function. T0 T1 T2 OI reflects oxygenation function. During OLV, the blood flowing through the collapsed lung fails to be oxygenated in Low dose group time, resulting in mixed venous blood after returning to the Medium dose group left heart and leading to hypoxemia. At this time, the body High dose group will initiate the mechanism of hypoxic pulmonary vaso- Figure 1: Cdyn levels (x± s). Note. *e abscissa represented the constriction to reduce the intrapulmonary shunt under time points, and the ordinate represented the detection level (ml/ hypoxia and protect the lung function [22–24]. *e study cmH O). *e Cdyn levels at T0, T1, and T2 in LDG were revealed that the appropriate increase in propofol dosage can (92.47± 12.19), (65.70± 9.25), and (70.16± 8.52). *e Cdyn levels at improve the diffusion of oxygen in the lungs and reduce the T0, T1, and T2 in MDG were (92.51± 12.25), (78.59± 9.41), and inhibitory effect of OLV on oxygenation, but excessive (85.05± 8.31). *e Cdyn levels at T0, T1, and T2 in HDG were propofol can also increase the risk of hypoxemia in patients. (92.73± 12.14), (82.22± 9.03), and (87.28± 8.40). from left to In addition, the abnormal release of inflammatory media- right represented notable differences in the Cdyn levels at T1 and ∗∗ tors, such as cytokines, is an important link in LIRI. In- T2 between LDG and MDG (t � 5.779, 7.401; P< 0.001). from left to right represented notable differences in the Cdyn levels at T1 flammatory mediators, such as TNF-α and ICAM-1, can and T2 between LDG and HDG (t � 7.501, 8.465; P< 0.001). increase the permeability of blood vessels, make the intra- vascular fluid and even red blood cells extravasate to form pulmonary interstitial edema, affect gas exchange, reduce the postoperative pulmonary edema [20, 21]. In this study, with secretion of pulmonary surfactant, and reduce the partial no notable difference at T0 among the three groups pressure of blood oxygen. SOD and MDA are significant (P> 0.05), the Cdyn levels significantly decreased at T1 indicators reflecting oxidation and antioxidant status in the (P< 0.05) and gradually increased at T2. *e Cdyn levels at body, in which the SOD level can reflect the ability of the body to scavenge free radicals, while MDA, a product of lipid T1 and T2 were remarkably higher in HDG and MDG than LDG (P< 0.05). *ey indicated that propofol can improve peroxidation, indirectly reflects the degree of tissue damage resulting from oxygen free radicals. In this research, no the lung compliance of patients, and the improvement effect gets more obvious with the increase of dosage, however, obvious difference was observed in the TNF-α and ICAM-1 there is no obvious difference in the improvement effect levels at T0 among the three groups (P> 0.05). *e TNF-α between propofol at 10 mg/(kg·h) and that at 5 mg/(kg·h). and ICAM-1 levels at T1 and T2 in MDG and HDG were *e P O levels gradually increased from T0 to T2 in the markedly lower compared with LDG, with no obvious A-a 2 three groups. With no notable differences at T0 and T1 difference between MDG and HDG (P> 0.05). *e results among the three groups (P> 0.05), the P O levels and RI were similar to the research of Yabuki et al. [25]. *e MDA A-a 2 values at T2 in MDG and HDG were lower compared with levels in the three groups increased gradually from T0 to T2, LDG (P< 0.05). *e RI values at T1 and T2 in HDG were and the levels at T1 and T2 in MDG and HDG were ml (cmH2O) Journal of Healthcare Engineering 5 Table 2: P O levels of patients (mmHg). A-a 2 Group T0 T1 T2 LDG 19.35± 2.06 25.16± 2.01 30.15± 4.28 MDG 19.38± 2.10 22.83± 2.14 24.15± 3.19 HDG 19.33± 2.08 23.95± 2.06 24.06± 3.15 Note: represented notable differences when compared with LDG (P< 0.05). Table 3: RI values of patients (x± s). Group T0 T1 T2 LDG 0.46± 0.15 0.69± 0.15 0.71± 0.15 MDG 0.49± 0.14 0.48± 0.13 0.52± 0.11 HDG 0.47± 0.13 0.51± 0.13 0.56± 0.12 Table 4: OI levels (mmHg). Group T0 T1 T2 ∗ ∗ LDG 445.10± 26.39 390.21± 18.50 370.25± 14.10 ∗ ∗ MDG 439.51± 25.77 385.37± 16.15 368.22± 14.82 HDG 448.63± 26.71 375.15± 25.20 330.42± 17.13 Note: represented notable differences when compared with HDG (P< 0.05). Table 5: Inflammatory factor levels of patients (x± s). TNF-α (ng/ml) Group T0 T1 T2 LDG 12.75± 2.04 25.33± 3.46 30.11± 3.29 ∗ ∗ MDG 12.71± 2.06 17.08± 2.05 18.50± 2.12 ∗∗ ∗∗ HDG 12.80± 2.10 16.97± 1.88 17.64± 2.07 ICAM-1 (pg/ml) Group T0 T1 T2 LDG 155.43± 19.27 260.72± 31.56 305.49± 40.35 ∗ ∗ MDG 155.28± 20.04 211.62± 31.25 235.09± 31.20 ∗∗ ∗∗ HDG 155.89± 20.10 203.50± 30.17 227.37± 31.04 ∗ ∗∗ Note: represented an obvious difference between MDG and LDG (P< 0.05). represented an obvious difference between HDG and LDG (P< 0.05). markedly higher compared with LDG (P< 0.05). *e results Table 6: Oxidative stress response of patients (x± s). further confirmed that increasing the dosage of propofol MDA (mmol/L) effectively reduces the inflammatory response and improves Group T0 T1 T2 oxidative stress, with a strong ability to scavenge free rad- LDG 4.61± 0.52 6.03± 0.78 10.35± 0.92 icals. *e above results suggest that the optimal dosage of ∗ ∗ MDG 4.58± 0.60 5.58± 0.49 8.12± 0.89 propofol should be selected in clinical practice according to ∗∗ ∗∗ HDG 4.63± 0.57 5.10± 0.41 7.88± 0.76 the actual treatment needs of patients combined with in- SOD (U/L) dicators such as physical fitness and body status, which can Group T0 T1 T2 be appropriately increased on the basis of 5 mg/(kg·h) but LDG 73.75± 7.83 64.73± 6.24 57.29± 7.14 not exceeding 10 mg/(kg·h). Logistic regression analysis was ∗ ∗ MDG 73.80± 7.91 69.64± 7.02 67.08± 6.19 performed on the clinical data of some OLV patients ad- ∗∗ ∗∗ HDG 73.71± 7.85 70.05± 6.95 67.42± 6.03 mitted to our hospital who underwent lobectomy. It was Note: represented an obvious difference between MDG and LDG found that Cdyn, P O , and OLV time were independent A-a 2 ∗∗ (P< 0.05). represented an obvious difference between HDG and LDG risk factors for LIRI in patients undergoing lobectomy. It is (P< 0.05). suggested that preoperative assessment and preparation should be made for patients, close attention should be paid markedly lower compared with LDG (P< 0.05). *e SOD to the changes in indicators such as Cdyn and P O , and A-a 2 levels in the three groups decreased gradually from T0 to T2, OLV time should be controlled as much as possible during and the levels at T1 and T2 in MDG and HDG were surgery. *e deficiencies of this study are as follows. 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Journal

Journal of Healthcare EngineeringHindawi Publishing Corporation

Published: Apr 21, 2022

References