肺保护性通气对肝移植手术患者肺损伤血清生物标志物和炎性因子的影响  

Effect of protective mechanical ventilation on plasma markers of lung injury and inflammatory mediators during general anesthesia for liver transplantation surgery

作　　者：董兰[1] 安丽娜[1] 岳阳[1] 蔡俊刚[1] 陈晓阳[1] 韩曙君[1] 

机构地区：[1]武警总医院麻醉科,北京市100039

出　　处：《临床麻醉学杂志》2017年第6期525-528,共4页Journal of Clinical Anesthesiology

基　　金：国家高技术研究发展计划(863计划)(2012AA021006)

摘　　要：目的观察肺保护性通气对肝移植手术患者肺损伤血清生物标志物和炎性因子的影响,探讨其对肝移植术后急性肺损伤(acute lung injury,ALI)的影响。方法选择行原位肝移植术的终末期肝病患者60例,男42例,女18例,年龄21~62岁,体重43~80kg,ASAⅡ~Ⅳ级。随机分为肺保护性通气组(P组)和非肺保护性通气组(U组),每组30例。所有患者分别于麻醉后手术开始前(T_1)、机械通气3h(T_2)、新肝期2h(T_3)及新肝期4h(T_4)检测肺动脉血中肺损伤血清生物标志物和炎性因子的水平,包括克拉拉细胞分泌蛋白16(CC16)、表面活性蛋白(SP-D)及高级糖基化终末产物可溶性受体(sRAGE)、TNF-α、IL-6及IL-8;于T_1~T_4、术后2h(T_5)、拔管前(T_6)及术后2d(T_7)行桡动脉血血气分析。记录患者术后清醒时间、拔管时间、ICU停留时间及ALI的发生情况。结果与T_1时比较,T_2~T_4时两组血清CC16浓度明显升高(P<0.05或P<0.01);T_3时两组SPD、sRAGE、TNF-α、IL-6及IL-8浓度明显升高(P<0.01);T_4时sRAGE、TNF-α、IL-6和IL-8浓度明显升高(P<0.05或P<0.01);T_2、T_5、T_6时两组氧合指数(OI)明显升高(P<0.05或P<0.01),T_4时P组明显降低(P<0.01),T_3、T_4时U组明显降低(P<0.01)。T_2、T_3时P组CC16浓度明显低于U组(P<0.05或P<0.01);T_3时P组OI明显高于U组(P<0.05);P组术后拔管时间明显短于U组[(8.9±3.2)h vs(9.3±2.8)h,P<0.05]。P组术后ALI 5例(16.6%),U组术后ALI 7例(23.3%),两组差异无统计学意义。结论肺保护性通气可改善肝移植手术患者的氧合指数,缩短拔管时间,减轻肺损伤。Objective To approach the effect of protective mechanical ventilation on acute lung injury after orthotopic liver transplantation,by observing changes of plasma markers of lung injury and inflammatory mediators.Methods Sixty patients scheduled for liver transplantation under general anesthesia,42 males and 18 females,aged 21-62 years,weighing 43-80 kg,ASA physical statusⅡ-Ⅳ,were randomly divided into 2groups：protective mechanical ventilation group（group P）and unprotective mechanical ventilation group（group U）.Pulmonary artery blood for plasma markers of lung injury and inflammatory mediators were collected at the following time points：before operation（T1）,3hours after mechanical ventilation（T2）,2hours（T3）and 4hours in neohepatic stage（T4）.These mediators included clara cell secretory protein（CC16）,surfactant proteins（SP-D）,soluble receptor for advanced glycation end-products（sRAGE）,TNF-α,IL-6and IL-8.Moreover,blood gas results were recorded at these 7time points：T1-T4,2hours after operation（T5）,before tracheal extubation（T6）and 2days after operation（T7）.The postoperative awakening time,tracheal extubation time,ICU stay time and the incidence of ALI were recorded.Results Compared with T1,plasma level of CC16 in the two groups increased at T2 and T3（P〈0.05 or P〈0.01）,however,plasma level of SP-D,sRAGE,TNF-α,IL-6 and IL-8 did not increase until T3（P 0.01）.Moreover,plasma level of sRAGE,TNF-α,IL-6and IL-8at T4 were higher than those at T1（P〈0.05 or P〈0.01）.Compared with T1,OIs in the two groups increased at T2,T5 and T6（P〈0.05 or P〈0.01）,while decreased at T4 in group P（P〈0.01）and at T3 and T4in group U（P〈0.01）.In group P,patients showed a lower plasma level of CC16 at T2and T3（P〈0.05 or P〈0.01）,a higher OI at T3（P〈0.05）and an earlier tracheal extubation after operation[（8.9±3.2）h vs（9.3±2.8）h,P〈0.05]compared with group U.There was no significant difference of acute lung injury incidence betw

关 键 词：肺保护性通气 急性肺损伤 肺损伤血清生物标志物 炎性因子 肝移植 

分 类 号：R614[医药卫生—麻醉学]