Effect of limb remote ischemic preconditioning combined with remote ischemic postconditioning on lung injury in thoracoscopic pulmonary lobectomy
WANG Yanzhen
GAO Changjun
ZHENG Lanlan
GUO Fei
LIU Chen
HAN Ruili
Abstract：Objective To investigate the effect of limb remote ischemic preconditioning(RIPC)combined with remote ischemic postconditioning(RIPostC)on lung injury and postoperative pulmonary complications(PPCs)in patients undergoing thoracoscopic pulmonary lobectomy.Methods A total of 150 patients who underwent elective thoracoscopic pulmonary lobectomy were included in this study.According to random number table method,they were divided into two groups,Group T and Group C,with 75 cases in each group.Three circles of ischemic preconditioning and postconditioning,namely 5 min ischemia/5 min reperfusion,were performed for Group T after the tourniquet was tied to one side of the upper arm before one-lung ventilation(OLV)and during the recovery of two-lung ventilation.The blood samples of non-ischemic radial artery were collected in the two groups before anesthesia induction,30 min after OLV,1 h after OLV,20 min after two-lung ventilation,6 h after operation,and 24 h after operation,and the arterial blood gas analysis was conducted to calculate oxygenation index(PaO2/FiO2),alveolar-arterial oxygen tension difference(A-aDO2),and respiratory index(RI).The mechanical ventilation parameters were recorded.The dynamic compliance,static compliance,and driving pressure were calculated.The plasma TNF-α,IL-6,and 1L-10 concentrations were measured at T1-T6.Also,the pulmonary complications during hospitalization and the average length of stay were recorded.Results Compared with T1,PaO2/FiO2 decreased and A-aDO2 increased in the two groups at T2-T6(P＜0.05).Compared with Group C,PaO2/FiO2 increased and A-aDO2 decreased in Group T at T3 and T5(P＜0.05).Compared with T1,RI increased in the two groups at T2-T6(P＜0.05).Compared with Group C,RI decreased in Group T at T2,T3,and T5(P＜0.05).There were no statistical differences in the plasma IL-6,IL-10 and TNF-α concentrations between the two groups at each time point(P＞0.05).Compared with Group C,the incidence of acute lung injury 24 h after surgery reduced and the postoperative length of stay was shortened in Group T(P＜0.05).Compared with Group C,both dynamic compliance and static compliance increased in Group T 30 min and 1 h after OLV(P＜0.05).Compared with T1,the driving pressure increased in the two groups at T2-T4(P＜0.05).Compared with Group C,the driving pressure decreased in Group T at T2 and T3(P＜0.05).Conclusion Limb RIPC combined with RIPostC can improve perioperative oxygenation,alleviate lung injury,and reduce PPCs in patients undergoing thoracoscopic pulmonary lobectomy.
Keywords：limb remote ischemic preconditioninglimb remote ischemic postconditioningone-lung ventilationpulmonary lobectomylung injury
Publication Date：2024-10-28
Online Publishing Date：2026-08-26(First online date of this platform, not the publication date of the document)
Pages：7( 1171-1177 )