肢体远隔缺血预处理联合远隔缺血后处理对胸腔镜肺切除术肺损伤的影响  

Effect of limb remote ischemic preconditioning combined with remote ischemic postconditioning on lung injury in thoracoscopic pulmonary lobectomy

作　　者：王彦珍 高昌俊 郑兰兰 郭飞 刘晨 韩瑞丽 WANG Yanzhen;GAO Changjun;ZHENG Lanlan;GUO Fei;LIU Chen;HAN Ruili(Department of Anesthesiology,Tangdu Hospital,Air Force Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学唐都医院麻醉科,陕西西安710038

出　　处：《空军军医大学学报》2024年第10期1171-1177,共7页Journal of Air Force Medical University

基　　金：陕西省自然科学基础研究计划重点项目(2023-JC-ZD-52);空军军医大学唐都医院学科创新发展计划项目(2021LCYJ029)。

摘　　要：目的观察肢体远隔缺血预处理(RIPC)联合远隔缺血后处理(RIPostC)对胸腔镜肺切除术后肺损伤以及术后肺部并发症(PPCs)的影响。方法纳入择期行胸腔镜肺切除术患者150例,根据随机数字表法分为两组,T组和C组,每组75例。T组于单肺通气(OLV)前和恢复双肺通气时将止血带绑于一侧上臂,实施5 min缺血/5 min再灌注3个循环的缺血预处理和后处理。采集两组患者麻醉诱导前、OLV 30 min、OLV 1 h、双肺通气后20 min、术后6 h、术后24 h时非缺血处理侧桡动脉血样,通过血气分析并记录吸入氧浓度来计算患者相应时点的氧合指数(PaO_(2)/FiO_(2))、肺泡-动脉氧分压差(A-aDO_(2))以及呼吸指数(RI)。记录机械通气相关参数,计算动态顺应性、静态顺应性以及驱动压。测定T_(1)~T_(6)时血浆TNF-α、IL-6、IL-10浓度,并统计患者住院期间肺部并发症及平均住院日情况。结果两组患者在T_(2)~T_(6)时PaO_(2)/FiO_(2)低于T_(1)、A-aDO_(2)高于T_(1)(P<0.05),与C组比较,T组于T_(3)、T_(5)时PaO_(2)/FiO_(2)升高、A-aDO_(2)降低(P<0.05)。两组患者RI于T_(2)~T_(6)时高于T_(1)(P<0.05),T组RI于T_(2)、T_(3)、T_(5)时低于C组(P<0.05)。两组患者血浆IL-6、IL-10、TNF-α浓度在各时点无统计学意义(P>0.05)。T组术后24 h急性肺损伤发生率以及术后住院时间均低于C组(P<0.05)。与C组比较,OLV后30 min和1 h时T组动态顺应性和静态顺应性升高(P<0.05)。两组患者驱动压于T_(2)~T_(4)时高于T_(1)(P<0.05),T组驱动压于T_(2)、T_(3)时低于C组(P<0.05)。结论肢体RIPC联合RIPostC能改善胸腔镜肺切除术围术期氧合,减轻肺损伤,减少PPCs。Objective To investigate the effect of limb remote ischemic preconditioning(RIPC)combined with remote ischemic postconditioning(RIPostC)on lung injury and postoperative pulmonary complications(PPCs)in patients undergoing thoracoscopic pulmonary lobectomy.Methods A total of 150 patients who underwent elective thoracoscopic pulmonary lobectomy were included in this study.According to random number table method,they were divided into two groups,Group T and Group C,with 75 cases in each group.Three circles of ischemic preconditioning and postconditioning,namely 5 min ischemia/5 min reperfusion,were performed for Group T after the tourniquet was tied to one side of the upper arm before one-lung ventilation(OLV)and during the recovery of two-lung ventilation.The blood samples of non-ischemic radial artery were collected in the two groups before anesthesia induction,30 min after OLV,1 h after OLV,20 min after two-lung ventilation,6 h after operation,and 24 h after operation,and the arterial blood gas analysis was conducted to calculate oxygenation index(PaO_(2)/FiO_(2)),alveolar-arterial oxygen tension difference(A-aDO_(2)),and respiratory index(RI).The mechanical ventilation parameters were recorded.The dynamic compliance,static compliance,and driving pressure were calculated.The plasma TNF-α,IL-6,and IL-10 concentrations were measured at T_(1)T_(6).Also,the pulmonary complications during hospitalization and the average length of stay were recorded.Results Compared with T_(1),PaO_(2)/FiO_(2)decreased and A-aDO_(2)increased in the two groups at T_(2)T_(6)(P<0.05).Compared with Group C,PaO_(2)/FiO_(2)increased and A-aDO_(2)decreased in Group T at T_(3)and T_(5)(P<0.05).Compared with T_(1),RI increased in the two groups at T_(2)T_(6)(P<0.05).Compared with Group C,RI decreased in Group T at T_(2),T_(3),and T_(5)(P<0.05).There were no statistical differences in the plasma IL-6,IL-10 and TNF-αconcentrations between the two groups at each time point(P>0.05).Compared with Group C,the incidence of acute lung injury 24 h after

关 键 词：肢体远隔缺血预处理 肢体远隔缺血后处理 单肺通气 肺切除术 肺损伤 

分 类 号：R614[医药卫生—麻醉学]