Discussion
ischemia/reperfusion, TNF-α, trauma, OI, pulmonary complications, organ dysfunction, lung damage, postoperative lung injury, alveolar hemorrhage, stress damage, pulmonary injury
INFLAMMATORY CELL INFILTRATION, SYSTEMIC INFLAMMATORY RESPONSE SYNDROME, PULMONARY COMPLICATIONS, SEPTIC SHOCK
This study showed that administration of penehyclidine hydrochloride and dexmedetomidine during anesthesia for cardiac valve surgery reduced the impact of CPB, cardiac surgery and anesthesia on lung damage, increased OI, and reduced release of inflammatory factors and the occurrence and severity of PPCs, thus improving the prognosis of patients. This is consistent with the previously reported protective effects of penehyclidine hydrochloride and dexmedetomidine on lungs during cardiac surgery or other pathological conditions [Penehyclidine hydrochloride is a novel anticholinergic agent and previous studies have focused on treatment of organophosphorus poisoning and septic shock. Shen Weifeng et al. reported that penehyclidine hydrochloride pretreatment significantly reduced pulmonary histopathological changes, inflammatory cell infiltration and alveolar hemorrhage induced by lipopolysaccharide in rats [PPCs are the main cause of increased morbidity and mortality in patients undergoing surgical anesthesia [In the current study, the PPC score of patients who used penehyclidine hydrochloride and dexmedetomidine was lower than that of patients who did not use either drug, and the PPC score of patients with combined penehyclidine hydrochloride and dexmedetomidine decreased more significantly. However, the application of penehyclidine hydrochloride or dexmedetomidine alone reduced the incidence of PPCs, but not significantly, and combination treatment significantly reduced the incidence of PPCs. We showed that after penehyclidine hydrochloride treatment, the proportion of patients with PPC score 1 increased significantly in the experimental group, while the score in the control group was mainly ≥ 3. These results suggested that penehyclidine hydrochloride or dexmedetomidine reduced the PPC score and severity of postoperative lung injury, but combination treatment reduced the occurrence of PPCs in patients undergoing cardiac surgery. The protective effects of penehyclidine hydrochloride and dexmedetomidine on pulmonary injury have been confirmed in many animal and human studies, but there are few studies on the effects of penehyclidine hydrochloride and dexmedetomidine on pulmonary complications. Dexmedetomidine has been shown to prevent pulmonary complications after oral and maxillofacial reconstruction [OI is negatively correlated with RI, and these are often used as indicators to evaluate lung function and gas ventilation and exchange. A decrease in OI value indicates a decline in pulmonary ventilation and exchange oxygenation, while a decrease in RI indicates strong pulmonary gas diffusion and exchange capacity and good ventilation volume. In the perioperative period of cardiac surgery with CPB, OI < 300 is usually defined as pulmonary injury [Factors such as CPB and surgical trauma can activate systemic inflammatory response syndrome and expand its cascade, which promotes release of proinflammatory cytokines such as TNF-α, leading to pulmonary injury after CPB and serious organ dysfunction after surgery [Therefore, prevention and reduction of inflammatory reaction during cardiac surgery with CPB are important for protecting the function of important organs, especially the lungs. Anesthesiologists can reduce the stress damage caused by surgery and CPB to patients by using anesthesia-related drugs and formulating appropriate anesthesia programs. The current study showed that, plasma IL-6 and TNF-α rose rapidly after CPB, reaching a peak at 6 h after CPB, and then decreasing at 24 h, but still significantly higher than preoperatively. This indicated that the inflammatory cascade reaction caused by surgical trauma, CPB, ischemia/reperfusion and other stresses continued into postoperative recovery. These results are consistent with previous animal and human studies in which penehyclidine hydrochloride or dexmedetomidine had an effect on inflammatory factors such as IL-6 and TNF-α [