Relationship between plasma P-selectin level and acute lung injury in patients with acute type A aortic dissection during the perioperative period

Objective To investigate the relationship between plasma P-selectin level and acute lung injury (ALI) in patients with acute type A aortic dissection (ATAAD) during the perioperative period. Methods Forty-six ATAAD patients were enrolled. According to the perioperative diagnostic criteria of ALI, the patients were divided into two groups: a preoperative ALI group (group A, n=24) and a preoperative non-ALI group (group NA, n=22). All the patients underwent total aortic arch replacement combined with stented elephant trunk implantation (the Sun's procedure) under general anesthesia and deep hypothermic circulatory arrest (DHCA). Arterial blood was collected before anesthesia induction (T0), at the end of operation (T1) and 12 h after operation (T2) for blood gas analysis, and oxygenation index (OI) was calculated. At the same time, venous blood was taken to detect plasma P-selectin level, platelet count (PC), mean platelet volume (MPV), and platelet distribution width (PDW). Results Patients in group A presented a lower OI than those in group NA at each time point (P<0.05). Compared with those at T0, OI decreased at T1 but increased at T2 for patients in group A, while OI decreased at T1 and T2 for patients in group NA (P<0.05). Compared with those in group NA, patients in group A produced an increased level of plasma P-selectin at each time point (P<0.05), and a decreased PC at T0 (P<0.05). Compared with those at T0, both groups produced increased levels of plasma P-selectin and PDW as well as decreased PC and MPV at T1 (P<0.05); and increased levels of plasma P-selectin and decreased PC at T2 (P<0.05). There was a negative correlation between plasma P-selectin level and OI (r=-0.793, P<0.05). Conclusions Many factors lead to platelet activation and an increased level of plasma P-selectin in ATAAD patients during the perioperative period, which is an important factor for ALI during the perioperative period. Perioperative measures to weaken platelet activation and reduce plasma P-selectin level may contribute to prevention and treatment of ALI. Key words: Dissection of aortic; P-selectin; Acute lung injury; Oxygenation index; Platelet