肢体缺血预处理对单肺通气的肺功能保护作用研究  

Protective effect of limb ischemic preconditioning on lung function during one-lung ventilation

作　　者：高峰[1] 赵春明[2] 孙玉荣[2] 温秋婷[2] 于秀文[2] 张晓杰[2] 王显艳[2] 张文华[1] 

机构地区：[1]齐齐哈尔医学院第三附属医院麻醉科,黑龙江齐齐哈尔161099 [2]齐齐哈尔医学院病理学院,黑龙江齐齐哈尔161006

出　　处：《中国现代医学杂志》2015年第35期53-57,共5页China Journal of Modern Medicine

基　　金：黑龙江省教育厅科学技术研究面上项目(No:12531804);齐齐哈尔市科学技术计划项目(No:SFGG-201309)

摘　　要：目的 探讨肢体缺血预处理对单肺通气（OLV）时肺功能的保护作用.方法 选取该院2013～2014年行食管癌根治术患者30例,随机分为缺血预处理组和对照组,每组15例.实验组行远端缺血预处理,对照组不行缺血预处理.分别在各时间抽取动脉血、静脉血及记录机械通气指标.结果 T0时间实验组与对照组的各指标比较,差异无统计学意义（P＞0.05）;OLV开始后,T1和T2时间,实验组与对照组的氧合指数（OI）显著降低,但实验组仍高于对照组（P＜0.05）;对照组的肺泡 动脉氧分压差（PA-aDO2）在T1时间明显升高（P＜0.05）,而实验组各时间比较,差异无统计学意义（P＞0.05）.两组患者T1、T2时间的血浆白细胞介素-1（IL-1）、白细胞介素-6（IL-6）及肿瘤坏死因子-α（TNF-0）水平显著升高（P＜0.05）,且对照组高于实验组（P＜0.05）;T3时间实验组的IL-1、IL-6及TNF-α基本恢复至T0时的水平（P＞0.05）,而对照组高于T0（P＜0.05）.结论 肢体缺血预处理可抑制OLV时因肺组织缺血/再灌注损伤所引起的炎症反应,降低肺损伤程度,加快肺功能恢复.[Objective] To study the protective effect of limb ischemic preconditioning on lung function during one-lung ventilation. [Methods] Thirty patients receiving esophageal cancer resection in our hospital from 2012 to 2014 were randomly allocated to experimental group and control group. The patients in the ex- perimental group all accepted distal isehemic preconditioning, while those in the control group did not. Breathing dynamics indicators, immunological parameters and blood indicators were recorded at 4 time points and compared. [Results] Oxygenation index （OI） at TI and T2 was lower than that at To in both groups, but OI of the experimental group was higher than that of the control group （P 〈 0.05）. PA-aDO： of the control group was significantly higher at TI （P 〈 0.05）, while that of the experimental group showed no significant change （P〉0.05）. In both groups plasma IL-1, IL-6 and TNF-o levels significantly increased at TI and T2 （P〈 0.05）, and they were higher in the control group than in the experimental group （/9〈 0.05）. At T3, IL-1, IL-6 and TNF-o in the experimental group returned to the level of To （P 〉 0.05）, but those in the control group were still higher than To levels （P 〈 0.05）. [ Conclusions] Limb ischemic preconditioning can inhibit the in- flammatory response caused by isehemia-reperfusion injury of lung tissue, which helps to reduce lung injury and accelerate the recove~ of hmg function.

关 键 词：缺血预处理 单肺通气 肺功能 食管癌 

分 类 号：R655.3[医药卫生—外科学] R614[医药卫生—临床医学]