Objective To investigate the effects of aerosolized inhalation of different doses of prostaglandin E1(PGE1) on pulmonary shunt and oxygenation during one-lung ventilation (OLV) when the fraction of inspiration O2 was 40%.
Methods A total of 156 patients undergoing radical operation of esophageal cancer, 121 males and 35 females, aged 18-64 years and BMI 18-30 kg/m2, ASA physical status Ⅱ or Ⅲ were included in the study. The patients were randomly assigned into 4 groups using a random number table: PGE1 0.1 μg/kg group (group L, n = 39), PGE1 0.2 μg/kg group (group M, n = 38), PGE1 0.3 μg/kg group (group H, n = 39), and a saline control group (group C, n = 40). Patients received different therapy before OLV, namely inhaling either PGE1 0.1, 0.2, 0.3 μg/kg, and saline into right lung for a duration of 10 minutes. Venous blood and arterial blood were drawn from right internal jugular vein catheter and radial artery catheter for blood gas analysis at pre-anesthesia (T0), pre-nebulization (T1), OLV 10 minutes (T2), OLV 15 minutes (T3), OLV 30 minutes (T4), OLV 60 minutes (T5), and OLV 120 minutes (T6). HR, MAP, PaO2, oxygenation index (OI), pulmonary shunt fraction (Qs/Qt), PaCO2, and peak airway pressure (Ppeak) were also recorded at above time points. Intraoperative hypoxemia, intraoperative hypotension, clinical pulmonary infection score (CPIS) on the second postoperative day and postoperative pulmonary complications (PPCs) within 7 days were recorded.
Results Compared with group C, groups L, M, and H showed a lower incidence of hypoxemia (P < 0.05), group H demonstrated lower MAP at T2 and T3 (P < 0.05), groups L, M, and H displayed lower Qs/Qt and higher PaO2 and OI at T2-T4(P < 0.05), group H had a lower CPIS on the second postoperative day (P < 0.05). Compared with group L, group H exhibited lower Qs/Qt at T2- T4, and higher PaO2 and OI at T3 and T4. There were no significant differences in the incidence of hypotension, HR, PaCO2, Ppeak, and the occurrence of PPCs within 7 days among the four groups.
Conclusion Nebulized inhalation of PGE1 0.1, 0.2 and 0.3 μg/kg under FiO2 40% before OLV can effectively reduce Qs/Qt, improve oxygenation and decrease the incidence of hypoxemia. However, it has no significant impact on PPCs. PGE1 0.3 μg/kg exhibits the best improvement in oxygenation and can also reduce CPIS on the second postoperative day, close monitoring of circulatory fluctuations is still required. |
