肺保护性通气对食管癌患者褪黑素和预后的影响  

Effects of protective ventilation on the production of endogenous melatonin and prognosis in esophageal cancer

作　　者：王丽霞[1] 王宇[2] 吴慧梅 刘学胜[1] 钱梅[1] Wang Lixia;Wang Yu;Wu Huimei(Dept of Anesthesiology,The First Affiliated Hospital of Anhui Medical University,Hefei 230022;Anhui Medical University,Hefei 230032;Dept of Geriatric Respiratory and Critical Care,The First Affiliated Hospital of Anhui Medical University,Hefei 230022)

机构地区：[1]安徽医科大学第一附属医院麻醉科,合肥230022 [2]安徽医科大学,合肥230032 [3]安徽医科大学第一附属医院老年呼吸与危重病科,合肥230022

出　　处：《安徽医科大学学报》2021年第8期1311-1315,共5页Acta Universitatis Medicinalis Anhui

基　　金：国家自然科学基金面上项目(编号:81770032)。

摘　　要：目的观察肺保护性通气策略对胸腹腔镜联合食管癌根治术患者内源性褪黑素、白细胞介素(IL)-1β和IL-18水平和预后的影响。方法择全麻下行胸腹腔镜联合食管癌根治术患者90例,随机分为常规通气组(Vt=10 ml/kg)或肺保护通气组[Vt=5 ml/kg合并5 cm H2O呼气末正压(PEEP)]。测量手术开始前及手术结束时支气管肺泡灌洗液(BALF)和血清中的褪黑素、IL-1β和IL-18水平。并记录术前双肺通气时、单肺通气30min和手术结束前的呼吸参数及患者术后第一天的血气指标和术后并发症。结果与常规通气组相比,肺保护通气降低了患者气道峰压(Ppeak),平台压(Pplat)和驱动压力(ΔP)。肺保护通气增高了术后第一天的氧分压值,降低血乳酸值(P<0.001)。且肺部保护性通气降低了术后肺部并发症(P=0.045)和术后总并发症(P=0.028)的发生率。肺保护通气组较常规组抑制了BALF和血清中IL-1β和IL-18的增加(P<0.001)。此外肺保护通气抑制BALF和血清中内源性褪黑素的降低(P<0.001)。结论肺部保护通气策略抑制IL-1β和IL-18的分泌且抑制内源性褪黑素水平降低,并降低了患者术后肺部及总并发症的发生率。Objective To investigate the effects of protective ventilation on the production of interleukin(IL)-1β,IL-18 and endogenous melatonin and prognosis of patients with esophageal cancer.Methods Ninety esophageal cancer patients were randomized to receive“conventional”ventilation(Vt=10 ml/kg)or lung protective ventilation[Vt=5 ml/kg along with 5 cm H 2O positive end-expiratory pressure(PEEP)].IL-1β,IL-18 and melatonin in bronchoalveolar lavage fluid(BALF)and serum were measured before and at the end of the operation.Respiratory variables during two-lung ventilation,one-lung ventilation for 30 min and at the end of the operation were recorded.Results of blood gas analysis on the first day after surgery and outcomes were evaluated.Results Compared with“conventional”ventilation group,lung protective ventilation decreased peak airway pressure(P peak),plateau airway pressure(P plat)and driving pressure(ΔP).Lung protective ventilation increased the partial pressure of oxygen on the first day after surgery and lowered the blood lactic acid values(P<0.001).In addition,lung protective ventilation reduced the incidence of postoperative pulmonary complications(P=0.045)and the rate of major postoperative complications(P=0.028).Moreover,lung protective ventilation not only suppressed alveolar and serum IL-1βand IL-18 secretion,but also restored the level of endogenous melatonin(P<0.001).Conclusion Lung protective ventilation suppresses IL-1βand IL-18 secretion,restores the level of endogenous melatonin and reduces the incidence of postoperative lung and total complications.

关 键 词：机械性肺损伤 肺保护性通气 NLRP3炎症小体 内源性褪黑素 炎症 

分 类 号：R614.2[医药卫生—麻醉学]