无呼吸性气流通气对胸腔镜下肺癌根治术单肺通气患者非通气侧肺损伤的改善作用及其机制  

Effect of apneic oxygen insufflation on non-ventilated lung injury in patients undergoing one-lung ventilation under thoracoscopic radical resection of lung cancer

作　　者：周俊辉[1] 钟巍[1] 奚高原[1] 王鹏浩 ZHOU Junhui;ZHONG Wei;XI Gaoyuan;WANG Penghao(Department of Anesthesiology,Henan Provincial Chest Hospital,Zhengzhou 450000,China)

机构地区：[1]河南省胸科医院郑州大学附属胸科医院麻醉科,郑州450000

出　　处：《山东医药》2023年第5期1-5,共5页Shandong Medical Journal

基　　金：河南省医学科技攻关计划联合共建项目(2018020564)。

摘　　要：目的通过观察无呼吸性气流通气(AOI)对胸腔镜下肺癌根治术单肺通气(OLV)患者非通气侧肺损伤的改善作用,探讨其相关机制。方法选择择期行胸腔镜下肺癌根治术的患者60例,随机分为对照组及AOI组各30例。于术中OLV开始即刻对AOI组患者非通气侧肺给予5L/min的氧气持续性通气,对照组患者非通气侧肺不给予氧气持续性通气。于麻醉诱导后即刻(T_(0))、OLV后30 min(T_(1))、OLV后1 h(T_(2))及OLV后2h(T_(3))采集患者桡动脉血,血气分析仪检测氧合参数动脉血氧分压(Pa O_(2))及动脉血二氧化碳分压(PaCO_(2))。术毕后保留已切除下来的肺癌组织,切取肿瘤周边的正常肺组织标本,HE染色观察肺组织病理学变化,评估肺损伤情况并计算肺损伤评分。采用TUNEL法观察肺组织细胞凋亡情况,计算细胞凋亡指数;采用Western blotting法测定肺组织中细胞凋亡相关蛋白B淋巴细胞瘤2(Bcl-2)、Bcl-2相关X蛋白(Bax),自噬相关蛋白微管相关蛋白1轻链3(LC3)-Ⅰ、LC3-Ⅱ、Beclin-1蛋白。记录术后3 d内患者发生的不良事件,包括呼吸抑制、窦性心动过缓、窦性心动过速、低血压、高血压及恶心呕吐。结果与同组T_(0)时点比较,对照组、AOI组T_(1)~T_(3)时点PaO_(2)降低、PaCO_(2)升高;与对照组同时点比较,AOI组T_(1)~T_(3)时点PaO_(2)升高、PaCO_(2)降低(P均<0.05)。HE染色显示,对照组肺组织结构发生明显损伤,AOI组肺组织损伤程度较对照组减轻;AOI组肺损伤评分低于对照组(P<0.05)。与对照组比较,AOI组细胞凋亡指数降低,肺组织Bcl-2、LC3-Ⅰ蛋白升高,Bax、Beclin-1、LC3-Ⅱ蛋白降低,Bcl-2/Bax、LC3-Ⅱ/LC3-Ⅰ增大(P均<0.05)。两组术后不良事件发生情况比较无统计学差异(P均>0.05)。结论OLV期间行AOI可改善胸腔镜下肺癌根治术OLV患者非通气侧肺损伤且安全性良好,该机制可能与AOI改善肺组织氧合状态、抑制细胞凋亡及自噬有关。Objective To observe the effect of apneic oxygen insufflation(AOI)on non-ventilated lung injury in patients undergoing one-lung ventilation(OLV)under thoracoscopic radical resection of lung cancer and to analyze its mechanism.Methods Sixty patients with lung cancer undergoing thoracoscopic radical resection were randomly divided into the control group and AOI group,with 30 patients in each.Continuous ventilation of 5L/min oxygen was given to the nonventilated lung in the AOI group at the onset of OLV during the operation,and continuous ventilation oxygen was not given to the non-ventilated lung in the control group.The radial artery blood was collected at the onset of induction of general anesthesia(T_(0)),30 min after OLV(T_(1)),1h after OLV(T_(2)),and 2h after OLV(T_(3)),and the oxygenation parameters including partial pressure of arterial blood oxygen(PaO_(2))and partial pressure of arterial blood carbon dioxide(PaCO_(2))were measured by blood gas analyzer.The resected lung cancer tissues were retained after the operation,and the normal lung tissue samples around the tumor were excised.HE staining was used to estimate the pathological changes of lung tissues,lung injury was evaluated,and the lung injury score was calculated.TUNEL method was used to observe the apoptosis of lung tissues and calculate the apoptosis index.Western blotting was used to determine the expression levels of apoptosis-related protein B-cell lymphoma-2(Bcl-2),Bcl-2 related X protein(Bax),and autophagy-related protein microtubule associated protein 1 light chain 3(LC3)-Ⅰ,LC3-Ⅱ,and Beclin-1 in the lung tissues.Adverse events which occurred within 3 days after operation were recorded,including respiratory depression,sinus bradycardia,sinus tachycardia,hypotension,hypertension,and nausea and vomiting.Results Compared with T_(0) time point of the same group,PaO_(2) decreased and PaCO_(2)increased at T_(1)-T_(3)time points in the control group and the AOI group;compared with the control group at the same time point,PaO_(2) increased and Pa

关 键 词：无呼吸性气流通气 单肺通气 肺损伤 细胞凋亡 细胞自噬 肺癌根治术 

分 类 号：R459.6[医药卫生—治疗学]