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| Effect of permissive hypercapnia on lung injury induced by tourniquet-related limb ischemic repufusion in elded patients |
| ZHOU Susu XU Hui SHU Shuhua CHAI Xiaoqing▲ |
| Department of Anesthesiology, the First Affiliated Hospital of University of Science and Technology of China Anhui Provincial Hospital, Anhui Province, Hefei 230001, China |
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Abstract Objective To investigate the effect of permissive hypercapnia on lung injury induced by tourniquet-related limb ischemic repufusion in elderly patients. Methods Sixty patients were scheduled for total knee replacement from January 2018 to January 2019 in Ward One, Department of Orthopedics of the First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital were selected, and were randomly divided into the normal ventilation group and permissive hypercapnia group by random number table method, 30 cases in each group. In the normal ventilation group, the partial pressure of carbon dioxide (PaCO2) was maintained at 35 to 45 mmHg, while in the permissive hypercapnia group, PaCO2 was maintained at 60 to 70 mmHg. The arterial blood gas analysis were performed and recorded before the induction of anesthesia (T0), 30 minutes (T1), 6 hours (T2) 24 hours (T3) and 48 hours (T4) after surgery of the two groups. The partial pressure of oxygen (PaO2) and PaCO2 were measured, while the oxygenation index (OI), alveolar-arterial oxygen difference [P(A-a)DO2], and respiratory index (RI) were calculated and recorded. Central venous blood samples were collected at the above time points, and the levels of serum tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), human complement 3a (C3a) and C-reactive protein (CRP) were determined by enzyme-linked immunosorbent assay (ELISA). Pulmonary complications and hospital stay were recorded at 72 h after surgery in both two groups. Results Compared with T0, the OI of two groups were significantly reduced, the [P(A-a)DO2] and RI were significantly increased between T1-T3 (P ＜ 0.05), the serum TNF-α concentration were significantly reduced, and the serum IL-10 concentration were significantly increased between T1-T4. The concentrations of serum C3a and CRP were increased significantly from T2-T4 (P ＜ 0.05). Compared with the normal ventilation group, the OI of permissive hypercapnia group were significantly increased, while (A-a)DO2 and RI were significantly reduced at T2-T3, and the concentration of serum TNF-a were significantly reduced, while the concentration of serum IL-10 were significantly decreased at T1-T4, the concentrations of serum C3a and CRP were significant decreased at T2-T3, and the hospital stay was significantly shorter (P ＜ 0.05). There were no significant differences in the incidence of complications such as wake-up time, pulmonary acute respiratory distress syndrome (ARDS) at 72 hours postoperatively, and pulmonary infection between the two groups (P ＞ 0.05). There were no atelectasis or pulmonary edema occurred in the two groups. Conclusion Permissive hypercapnia can reduce lung injury caused by ischemia-reperfusion of tourniquet-related limbs in elderly patients, and improve lung oxygenation and diffuse function. The mechanism may be related to the suppression of inflammatory responses.
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