术前肢体远隔缺血预处理对食管癌根治性手术患者单肺通气相关性肺损伤的作用及影响  

The Clinical Efficacy of Limb Remote Ischemic Preconditioning on Single Lung Ventilation Related Lung Injury in Patients Undergoing Radical Surgery for Esophageal Carcinoma

作　　者：苏孟勤[1] 钟巍[1] 

机构地区：[1]河南省胸科医院麻醉科,河南郑州450000

出　　处：《医学与哲学（B）》2016年第5期30-32,68,共4页Medicine & Philosophy(B)

摘　　要：探讨术前肢体远隔缺血处理后对患者单肺通气相关性肺损伤的作用。择期行食管癌根治性手术的患者60例,平均随机分为肢体远隔缺血预处理组（R组）和对照组（C组）。单肺通气前（T_1）、单肺通气后30min（T_2）、60min（T_3）、90min（T_4）、单肺通气结束即刻（T_5）、单肺通气结束后30min（T_6）时行动脉血气分析,计算各组氧合指数、呼吸指数和PaO_2/PAO_2,收集呼出气冷凝液测pH值,ELISA法测血浆TNF-α、IL-1β和IL-10浓度。与C组比较,R组T_2-T_6时刻氧合指数升高,呼吸指数降低,PaO_2/PAO_2升高,T_3-T_6时血浆TNF-α和IL-1β浓度降低,呼出气冷凝液pH值升高,T_2-T_6时血浆IL-10浓度升高（P〈0.05）。术前肢体远隔缺血处理后可在一定程度上减轻食管癌根治性手术患者单肺通气相关性肺损伤。To evaluate the clinical efficacy of limb remote ischemic preconditioning on one lung ventilation（OLV）related lung injury in patients undergoing radical surgery for esophageal carcinoma.Sixty patients diagnosed with esophageal carcinoma and scheduled for radical surgery for esophageal carcinoma were randomly assigned to 2 groups（n=40）：remote ischemic preconditioning（RIPC）group（group R）and control group（group C）.In group R,RIPC was induced by 3 cycles of lower extremity ischemia for 5 min then reperfusion 5 min after tracheal intubation.Blood gas analysis was implemented at time before one-lung ventilation（T1）,and 30min（T2）,1h（T3）and 1.5h（T4）after OLV,the moment after completion of OLV（T5）and 30 min after completion of OLV（T6）to test plasma concentrations of tumor necrosis factor-α（TNF-α）,interleukin-1β（IL-1β）and IL-10.Oxygenation index（OI）,respiratory index（RI）and PaO2/PAO2 were calculated.Exhaled breath condensate was collected to check pH value.Compared with group C,oxygenation index was significantly increased,while respiratory index was decreased at T2-T6.The plasma concentrations of TNF-αand IL-1β were decreased,and pH value of exhaled breath condensate was increased at T3-T6.The plasma concentration of IL-10 increased at T2-T6 in group RIPC.RIPC can release the inflammatory responses cause by OLV and attenuate acute lung injury in the patients undergoing thoracic surgery.

关 键 词：肢体远隔缺血预处理 单肺通气相关性肺损伤 食管癌根治性手术 肺保护 

分 类 号：R614.2[医药卫生—麻醉学]