非通气侧肺持续中低流量给氧对患者肺泡巨噬细胞凋亡及自噬的抑制作用  

Inhibiting effect of continuous low and medium flow oxygen in non-ventilated side lung on apoptosis and autophagy of alveolar macrophage in patients

作　　者：周俊辉[1] 孟宪慧[1] 高洁 ZHOU Junhui;MENG Xianhui;GAO Jie(Department of Anesthesiology,Henan Provincial Chest Hospital,Zhengzhou,Henan 450008,China;Department of Anesthesiology,People′s Hospital of Zhengzhou University,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省胸科医院麻醉科,郑州450008 [2]郑州大学人民医院麻醉科,郑州450003

出　　处：《重庆医学》2021年第14期2454-2458,共5页Chongqing medicine

基　　金：河南省医学科技攻关计划-联合共建项目(2018020564);河南省医学科技攻关计划联合共建项目(LHGJ20200220);河南省重点研发与推广专项(科技攻关)项目(212102310720)。

摘　　要：目的探讨单肺通气(OLV)时非通气侧肺持续中低流量给氧对老年患者肺泡巨噬细胞(AM)凋亡及自噬的影响。方法择期行胸腔镜下肺癌根治术的老年患者60例,年龄65~80岁,分成研究组和对照组,每组30例。OLV后研究组患者非通气侧肺给予1~4 L/min的持续性中低流量给氧,对照组患者非通气侧肺不给予持续性中低流量给氧。于麻醉诱导后即刻(T0),OLV后30 min(T1)、1 h(T2)及2 h(T3)时采集桡动脉血并测定动脉血氧分压(PaO_(2))和二氧化碳分压(PaCO_(2))。T3时留取肺癌周边正常的肺组织,光镜下观察肺组织病理学并进行肺组织损伤评分。T3时采集支气管肺泡灌洗液(BALF)并采用流式细胞术分选AM并测定凋亡率,Western blot检测AM内B淋巴细胞瘤-2基因(Bcl-2)、Bcl-2相关X蛋白(Bax)、微管相关蛋白1轻链3(LC3)和Beclin-1蛋白表达量,计算Bcl-2/Bax比值和LC3-Ⅱ/LC3-Ⅰ比值。结果与T0时比较,T1~3时两组PaO_(2)均显著下降(P<0.05),PaCO_(2)均显著升高(P<0.05)。T1~3时研究组PaO_(2)较对照组均显著升高(P<0.05),PaCO_(2)较对照组均显著降低(P<0.05)。对照组肺泡壁增厚、水肿,可见大量中性粒细胞和单核细胞,肺泡腔内可见较多炎性渗出,肺间质明显增生可见大量炎性细胞浸润。研究组肺泡间隔增宽,毛细血管未见明显充血,小部分肺泡腔可见红细胞及炎性渗出液,肺间质炎性细胞浸润明显减少。T3时研究组肺损伤评分较对照组明显降低(P<0.05)。与对照组相比,研究组AM存活细胞率明显升高(P<0.05),AM早期凋亡率和晚期凋亡率明显降低(P<0.05)。与对照组比较,研究组AM内Bcl-2、LC3-Ⅰ蛋白表达量明显升高(P<0.05),Bax、LC3-Ⅱ和Beclin-1蛋白表达量均明显降低(P<0.05),Bcl-2/Bax比值明显升高(P<0.05),LC3-Ⅱ/LC3-Ⅰ比值明显降低(P<0.05)。结论老年患者胸腔镜下肺癌根治术中非通气侧肺持续中低流量给氧可减轻非通气侧肺损伤,其机制可能与抑制AM细胞凋亡�Objective To investigate the effects of continuous low and medium flow oxygen in one lung ventilation(OLV)on apoptosis and autophagy of alveolar macrophage(AM)in aged patients.Methods Sixty patients aged 65-80 years old undergoing elective thoracoscopic radical resection of lung cancer were divided into the study group and control group,30 cases in each group.After OLV,the study group was given continuous low-to-medium flow oxygen at 1 to 4 L/min to the non-ventilated side lung,while the control group was not given continuous low-to-medium flow oxygen to the non-ventilated side lung.The radial arterial blood was collected immediately after induction of anesthesia(T0),at 30 min(T1),1 h(T2),and 2 h(T3)after OLV and the PaO_(2) and PaCO_(2) were measured.The normal lung tissues around the lung cancer were excised at T3,and the pathological changes of the lung tissue were observed under the light microscope and the lung tissue injury score was performed.The bronchoalveolar lavage fluid(BALF)was collected at T3 and AM was sorted by flow cytometry to determine the apoptotic rate.The expression levels of Bcl-2,Bax,LC3 and Beclin-1 protein were tested by Western blot,and Bcl-2/Bax ratio and LC3-Ⅱ/LC3-Ⅰratio were calculated.Results Compared with at T0,PaO_(2) at T1-3 in the two groups was decreased significantly(P<0.05),and PaCO_(2) was increased significantly(P<0.05).At T1-3,PaO_(2) of the study group was significantly higher than that of the control group(P<0.05),while PaCO_(2) was significantly decreased compared with that of the control group(P<0.05).In the control group,the alveolar walls were thickened,edema occured and a large number of neutrophils and monocytes were seen.There were more inflammatory exudates in the alveolar cavity,and a large number of inflammatory cell infiltrations were seen in the pulmonary interstitial hyperplasia.In the study group,the alveolar compartment was widened,the capillaries were not significantly congested,red blood cells and inflammatory exudate were seen in a small part of the

关 键 词：肺通气 肺泡巨噬细胞 肺损伤 细胞凋亡 自噬 老年人 

分 类 号：R619.9[医药卫生—外科学]