单肺通气时非通气侧肺持续中低流量给氧在老年患者肺癌根治术中的应用  

Application of continuous low-and medium-flow oxygen in non-ventilated lung on ferroptosis of alveolar macrophage during radical lung cancer in elderly patients

作　　者：张洪军 苗亚飞 刘相乐 麻黎斯 司建洛[1] ZHANG Hongjun;MIAO Yafei;LIU Xiangle;MA Lisi;SI Jianluo(Department of Anesthesiology,the First Affiliated Hospital of Henan University of Science and Technology,Clinical Medical College of Henan University of Science and Technology,Luoyang 471003,China)

机构地区：[1]河南科技大学临床医学院河南科技大学第一附属医院麻醉科,洛阳市471003

出　　处：《临床麻醉学杂志》2021年第9期906-912,共7页Journal of Clinical Anesthesiology

基　　金：河南省医学科技攻关计划-联合共建项目(2018020564)。

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癌根治术中肺泡巨噬细胞(AM)铁死亡的影响。方法选择2019年12月至2020年8月择期行胸腔镜下肺癌根治术的老年患者60例,男31例,女29例,年龄65~80岁,BMI 18~25 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字表法将患者分为两组:观察组和对照组,每组30例。OLV时观察组非通气侧肺给予1~4 L/min持续性中低流量给氧,对照组非通气侧肺不给予持续性中低流量给氧。于术前(T_(0),基础值)、麻醉诱导后即刻(T_(1))、OLV后30 min(T_(2))、1 h(T_(3))、2 h(T_(4))采集桡动脉血并测定SpO_(2)、PaO(2)和PaCO_(2),计算氧合指数(OI=PaO_(2)/FiO_(2))。记录术前一秒用力呼气容积(FEV_(1))/用力肺活量(FVC)比值。T_(3)时采集支气管肺泡灌洗液(BALF),采用流式细胞术分选AM,比色法测定AM内Fe^(2+)、丙二醛(MDA)浓度和超氧化物歧化酶(SOD)活性,Western blot法检测AM内长链脂酰辅酶A合成酶4(ACSL4)及谷胱甘肽过氧化物酶4(GPX4)蛋白含量。T_(3)时切取肺癌周边正常肺组织,采用HE染色,光镜下观察肺组织病理学并进行肺组织损伤评分。记录PACU停留时间和住院时间,记录肺部并发症以及呼吸抑制、窦性心动过缓、窦性心动过速、高血压、低血压、恶心呕吐等不良事件发生情况。结果与T_(0)时比较,两组T_(1)—T_(4)时SpO_(2)明显升高(P<0.05),T_(1)时PaCO_(2)明显降低(P<0.05);对照组T_(1)和T_(3)时PaO(2)明显升高(P<0.05),T_(2)—T_(4)时PaCO_(2)明显升高(P<0.05),T_(1)时OI明显升高(P<0.05),T_(2)—T_(3)时OI明显降低(P<0.05);观察组T_(1)—T_(4)时PaO_(2)明显升高(P<0.05),T_(3)时PaCO_(2)明显降低(P<0.05),T_(1)、T_(3)、T_(4)时OI明显升高(P<0.05)。与对照组比较,观察组T_(2)—T_(4)时SpO_(2)、PaO_(2)和OI明显升高(P<0.05),PaCO_(2)明显降低(P<0.05);T_(3)时肺损伤评分明显降低(P<0.05),AM内Fe^(2+)、MDA浓度明显降低(P<0.05),SOD活性明显升高(P<0.05),ACSLObjective To investigate the effects of continuous low-and medium-flow oxygen in non-ventilated lung on ferroptosis of alveolar macrophage during radical lung cancer in aged patients.Methods Sixty patients undergoing thoracoscopic radical resection of lung cancer from December 2019 to August 2020,31 males and 29 females,aged 65-80 years,BMI 18-25 kg/m^(2),ASA physical statusⅡorⅢ,were divided into observation group and control group according to the random number table method,30 patients in each group.After one-lung ventilation,the observation group was given continuous low-to-medium flow oxygen at 1-4 L/min to the non-ventilated side lungs,while the control group was not given continuous low-to-medium flow oxygen to the non-ventilated side lungs.Radial arteries were collected before surgery(T_(0),base line),immediately after induction of anesthesia(T_(1)),30 minutes(T_(2)),1 hour(T_(3))and 2 hours(T_(4))after OLV,SpO_(2),PaO_(2) and PaCO_(2) were measured,and oxygenation index(OI=PaO_(2)/FiO_(2))was calculated.The ratio of forced expiratory volume(FEV_(1))/forced vital capacity(FVC)in one second before operation,general conditions and operation related conditions of patients were recorded.Bronchoalveolar lavage fluid(BALF)was collected at T_(3)and AM was sorted by flow cytometry.Colorimetric method was used to determine the concentration of Fe^(2+),MDA and SOD activity in AM,and Western blot was used to detect the expression of long-chain acyl-CoA synthase 4(ACSL4)and glutathione peroxidase 4(GPX4)in AM.Normal lung tissues around the lung lobe to be resected were excised,and the pathological changes of the lung tissue were observed under a light microscope using HE staining and the lung injury score was performed at T_(3).The stay time of postanesthesia car unit(PACU),hospital stay and the incidence of pulmonary complications and major adverse events before discharge such as respiratory depression,sinus bradycardia,sinus tachycardia,hypertension,hypotension,nausea and vomiting were also recorded.Results Compa

关 键 词：肺通气 肺泡巨噬细胞 肺损伤 铁死亡 老年 

分 类 号：R734.2[医药卫生—肿瘤] R614[医药卫生—临床医学]