急性肺损伤(ALI)经常发生在电视胸腔镜手术(VATS)后。铁凋亡与几种肺部疾病有关。因此,两种常用麻醉药(七氟醚(Sev)和异丙酚)对VATS诱导的ALI的不同作用和潜在机制尚需阐明.在本研究中,纳入的患者被随机分配至接受Sev(S组)或丙泊酚麻醉(P组).术中充氧,肺组织形态,ZO-1、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6),超氧化物歧化酶(SOD),谷胱甘肽(GSH),Fe2+,谷胱甘肽过氧化物酶4(GPX4),和肺组织中磷酸肌醇3激酶(PI3K)/蛋白激酶B(AKT)/核因子红细胞相关因子2(Nrf2)/血红素加氧酶-1(HO-1)通路以及血浆中TNF-α和IL-6的表达。记录术后并发症。在计划接受VATS的85名最初筛查的患者中,62人被纳入S组(n=32)或P组(n=30)。与异丙酚相比,Sev实质上(1)改善了术中氧合;(2)减轻了组织病理学肺损伤;(3)增加了ZO-1蛋白的表达;(4)降低了肺组织和血浆中TNF-α和IL-6的水平;(5)增加了GSH和SOD的含量,但降低了Fe2浓度;(6)上调了p-AKT的蛋白表达。Nrf2、HO-1和GPX4。两组之间在术后结局的发生没有显着差异。总之,Sev处理,与异丙酚麻醉相比,可以通过激活PI3K/Akt/Nrf2/HO-1途径和抑制铁凋亡来抑制局部肺和全身炎症反应。这种级联效应有助于维持肺上皮屏障通透性,减轻肺损伤,并增强VATS患者的术中氧合。
Acute lung injury (ALI) frequently occurs after video-assisted thoracoscopic surgery (VATS). Ferroptosis is implicated in several lung diseases. Therefore, the disparate effects and underlying mechanisms of the two commonly used
anesthetics (
sevoflurane (Sev) and propofol) on VATS-induced ALI need to be clarified. In the present study, enrolled patients were randomly allocated to receive Sev (group S) or propofol anesthesia (group P). Intraoperative oxygenation, morphology of the lung tissue, expression of ZO-1, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), superoxide dismutase (SOD), glutathione (GSH), Fe2+, glutathione peroxidase 4 (GPX4), and phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/nuclear factor erythroid-2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) pathway in the lung tissue as well as the expression of TNF-α and IL-6 in plasma were measured. Postoperative complications were recorded. Of the 85 initially screened patients scheduled for VATS, 62 were enrolled in either group S (n = 32) or P (n = 30). Compared with propofol, Sev substantially (1) improved intraoperative oxygenation; (2) relieved histopathological lung injury; (3) increased ZO-1 protein expression; (4) decreased the levels of TNF-α and IL-6 in both the lung tissue and plasma; (5) increased the contents of GSH and SOD but decreased Fe2+ concentration; (6) upregulated the protein expression of p-AKT, Nrf2, HO-1, and GPX4. No significant differences in the occurrence of postoperative outcomes were observed between both groups. In summary, Sev treatment, in comparison to propofol anesthesia, may suppress local lung and systemic inflammatory responses by activating the PI3K/Akt/Nrf2/HO-1 pathway and inhibiting ferroptosis. This cascade of effects contributes to the maintenance of pulmonary epithelial barrier permeability, alleviation of pulmonary injury, and enhancement of intraoperative oxygenation in patients undergoing VATS.