肺癌根治术中非通气侧肺持续中-低流量给氧对老年患者肺泡巨噬细胞的影响  

Effects of continuous low-and medium-flow oxygen in non-ventilated lung on alveolar macrophage in aged patients undergoing radical resection of lung cancer

作　　者：钟巍[1] 周俊辉[1] 高洁 房芳 刘晓乐[1] 张娜娜 孟宪慧[1] ZHONG Wei;ZHOU Junhui;GAO Jie;FANG Fang;LIU Xiaole;ZHANG Nana;MENG Xianhui(Department of Anesthesiology,Henan Provincial Chest Hospital,Zhengzhou 450008,Henan,China;不详)

机构地区：[1]河南省胸科医院麻醉科,河南郑州450008 [2]中国医学科学院阜外医院麻醉科

出　　处：《上海医学》2022年第1期22-27,共6页Shanghai Medical Journal

基　　金：河南省医学科技攻关计划项目(201602299);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-低流量给氧对胸腔镜下行肺癌根治术的老年患者非通气侧肺损伤时肺泡巨噬细胞(AM)的影响。方法纳入2018年12月20日—2019年9月5日择期行胸腔镜下肺癌根治术的老年患者60例,年龄65~80岁,采用随机数字表法分成研究组和对照组,每组30例。OLV后研究组对非通气侧肺给予1~4 L/min的持续性中-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。于麻醉诱导后即刻(T_(0)),OLV后30 min(T_(1))、1 h(T_(2))及2 h(T_(3))时采集桡动脉血,测定动脉血氧分压(paO_(2))和动脉血二氧化碳分压(paCO_(2))。T_(3)时留取肺癌周边正常的肺组织,于光学显微镜下观察肺组织病理学并进行肺损伤评分;采集支气管肺泡灌洗液(BALF),采用流式细胞术分选AM并测定凋亡率及其细胞内钙离子(Ca^(2+))和M1型标志物活性氧簇(ROS)浓度。采用ELISA法检测BALF中AM M1型标志物诱导型一氧化氮合酶(iNOS)、IL-6、TNF-α和M2型标志物精氨酸酶1(Arg-1)、IL-10。结果T_(1)~T_(3)各时间点研究组paO_(2)显著高于对照组(P值均<0.05),paCO_(2)显著低于对照组(P值均<0.05)。T_(3)时研究组肺损伤评分[(8.1±1.9)分]、BALF中AM早期和晚期凋亡率[(23.12±5.32)%、(9.42±4.08)%]均显著低于对照组[(16.3±3.5)分、(33.51±6.48)%、(22.67±5.93)%,P值均<0.05]。研究组BALF中AM内iNOS、IL-6、TNF-α、ROS水平均显著低于对照组,Arg-1、IL-10水平和Ca^(2+)浓度均显著高于对照组(P值均<0.05)。结论胸腔镜肺癌根治术中非通气侧肺持续中-低流量给氧可调节老年患者异常的AM表型与功能,抑制AM凋亡,并可减轻非通气侧肺损伤。Objective To investigate the effect of continuous low-and medium-flow oxygen in non-ventilated lung on alveolar macrophage(AM)in patients undergoing thoracoscopic radical lung cancer.Methods Sixty patients with lung cancer,aged 65-80 years old,scheduled for thoracoscopic radical resection between December 20th 2018 and September 5th 2019 were divided into test group and control group according to random number table method(30 cases in each group).After one-lung ventilation,non-ventilated lungs were continuously given flow oxygen at 1 to 4 L/min in the test group,while the control group was not given continuous low-to-medium flow oxygen to the non-ventilated lungs.Blood samples from radialis artery were collected immediately(T_(0)),30 min(T_(1)),1 h(T_(2)),and 2 h(T_(3))after induction of anesthesia,and the arterial blood oxygen pressure(paO_(2))and arterial blood carbon dioxide pressure(paCO_(2))were measured.At T_(3),normal lung tissues around the resected lung lobe were excised,pathological changes of the lung tissue were observed under a light microscope and the lung injury score was performed.Bronchoalveolar lavage fluid(BALF)was collected at T_(3) and AM was sorted by flow cytometry to determine apoptotic rate;the concentrations of intracellular Ca^(2+) and reactive oxygen species(ROS)as AM M1 type marker were tested.Enzyme-linked immunosorbent assay(ELISA)was used to detect the concentrations of AM M1 type markers including inducible nitric oxide synthase(iNOS),interleukin 6(IL-6),and tumor necrosis factor alpha(TNF-α)and AM M2 type markers including arginase 1(Arg-1)and interleukin 10(IL-10)in BALF.Results Compared with those in the control group,paO_(2) were significantly increased,while paCO_(2) were significantly decreased at T_(1)-T_(3) in the test group(all P<0.05).The lung injury score at T_(3),early and late proportion of AM apoptosis in BALF in the control group were significantly higher than those in the test group(16.3±3.5 vs.8.1±1.9,33.51%±6.48%vs.23.12%±5.32%,22.67%±5.93%vs.9.42%±4.08%,a

关 键 词：肺通气 巨噬细胞 肺泡 急性 肺损伤 细胞凋亡 胸外科手术 

分 类 号：R734.2[医药卫生—肿瘤]