WU Jie,WANG Qingxiu,XU Xiaocao.Effect of preoporative sublingual melatonin on postoperative inflammation and pulmonary complications in patients undergoing thoracoscopic lobectomy[J].同济大学学报（医学版）,2022,43(5):632-638. [点击复制]
Effect of preoporative sublingual melatonin on postoperative inflammation and pulmonary complications in patients undergoing thoracoscopic lobectomy
WU Jie,WANG Qingxiu,XU Xiaocao
(Department of Anesthesiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China;Laboratory Department, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China)
Abstract:
ObjectiveTo observe the effect of the preoperative application of melatonin on postoperative inflammation and pulmonary complications in patients undergoing thoracoscopic lobectomy. MethodsFrom June 2020 to February 2021, 83 patients who underwent thoracoscopic lobectomy at the Department of Thoracic Surgery, Tongji University Affiliated East Hospital, were randomly divided into melatonin group(Group M) and control group(group C). Group M received sublingual melatonin 0.4mg/kg 30min before entering the operation room; group C did not do any treatment. Both groups were given midazolam 0.04mg/kg, propofol 1.5-2.5mg/kg, sufentanil 0.6μg/kg, and rocuronium 0.6mg/kg to induce anesthesia. Both groups were given dexmedetomidine 0.5μg/kg intravenously, Teraline(parecoxib sodium for injection) 40 mg preemptive analgesia. And perform double-lumen bronchial intubation under visual laryngoscopy, and check the correct placement position with fiberoptic bronchoscopy. Intravenous continuous pump injection of propofol 4-8mg/(kg·h), remifentanil 0.05-0.2μg/(kg·min), and cis-atracurium 0.1-0.15mg/(kg·h) to maintain the BIS value between 40-60; Postoperatively, PCIA is used for analgesia. Observe and record the incidence of postoperative pulmonary complications(pulmonary infection, pneumothorax, pleural effusion, atelectasis, respiratory failure, etc.). The incidence of postoperative pulmonary complications were documented, Neutrophils/lymphocytes(NLR) and platelets/lymphocytes(PLR) before operation and 2h, 24h, 48h after operation were calculated; serum interleukin 6(IL-6), C-reactive protein(CRP), and superoxide dismutase(SOD) were measured before and 2h, 48h after operation. The VAS scores at PACU and 2h, 24h, 48h after operation, the length of hospital stay, and the use of intraoperative analgesics were documented. ResultsCompared with group C, the NLR, PLR, CRP, IL-6 levels in group M were decreased and SOD increased significantly(all P<0.05). Compared with group C, the overall incidence of postoperative pulmonary complications in group M was significantly lower(P<0.05). In addition, the M group significantly reduced the PACU VAS scores of patients after surgery, but it had no significant effect on the VAS scores of 2h, 12h, 24h and the use of opioids in the operation(P>0.05). ConclusionSublingual administration of melatonin in patients undergoing thoracoscopic lobectomy can reduce postoperative inflammation, and the incidence of postoperative pulmonary complications. At the same time, it can reduce the VAS pain score in PACU, but it has no significant effect on the use of related analgesics.
