胸科手术单肺通气对肺免疫功能的影响  

Pulmonary immune effects of one-lung ventilation in patients undergoing thoracic surgery

作　　者：吴静波[1] 蔡杰衡[1] 陈志峰[1] 马翔[1] 

机构地区：[1]广东药学院附属第一医院麻醉科,广东广州510080

出　　处：《东南大学学报（医学版）》2014年第3期322-327,共6页Journal of Southeast University(Medical Science Edition)

摘　　要：目的:探讨单肺通气(OLV)时不同潮气量(VT)对肺免疫功能、血流动力学和气体交换的影响。方法:将40例开胸手术患者随机分为2组,每组20例,分别以10 ml·kg-1和5 ml·kg-1的VT进行OLV,期间维持二氧化碳分压(PaCO2)在正常水平。通气侧肺行纤维支气管镜肺泡灌洗,测定灌洗液中的细胞数、蛋白、肿瘤坏死因子(TNF)-α、白介素(IL)-8、IL-10、可溶性细胞间黏附分子(sICAM-1)以及弹性蛋白酶的含量。结果:所有患者均表现为促炎反应变量的增加。两组患者肺泡内细胞数、蛋白、白蛋白、IL-8、弹性蛋白酶和IL-10的时相变化在OLV后和术后均未见差异,但TNF-α和sICAM-1在5 ml·kg-1组显著低于10 ml·kg-1组。结论:机械通气(MV)可能导致通气侧肺的内皮损伤和促炎反应,OLV时减小VT可降低肺泡内TNF-α、sICAM-1的浓度。Objective： To study the influence of one-lung ventilation （ OLV ） with different tidal volumes on pulmonary immune function , hemodynamics, and gas exchange .Methods：Forty patients undergoing open thoracic surgery were randomized to receive either mechanical ventilation （ MV） with VT=10 ml· kg -1 （ n=20 ） or VT=5 ml· kg -1 （ n =20 ） adjusted to normal PaCO 2 during and after OLV .Fiberoptic bronchoalveolar lavage of the ventilated lung was performed, and cells, protein, tumor necrosis factor（TNF-α）, interleukin（IL）-8, soluble intercellular adhesion molecule （ slCAM-1 ） , IL-10 , and elastase were determined in the bronchoalveolar lavage . Data were analyzed by parametric or nonparametric tests as indicated .Results： In all patients, an increase of proinflammatory variables was found.The time courses of intra-alveolar cells, protein, albumin, IL-8, elastase, and IL-10 did not differ between the two groups after OLV and postoperatively .TNF-αand sICAM-1 concentrations were significantly smaller after OLV with VT =5 ml· kg -1 .Conclusion： MV may induce epithelial damage and a proinflammatory response in the ventilated lung .Reduction of tidal volume during OLV may reduce alveolar concentrations of TNF-αand sICAM-1 .

关 键 词：机械通气 肺 免疫 单肺通气 

分 类 号：R655.3[医药卫生—外科学]