胸科手术单肺通气对肺免疫功能的影响-东南大学学报医学版

胸科手术单肺通气对肺免疫功能的影响

单位：广东药学院附属第一医院麻醉科, 广东广州 510080

分类号：R655.3

出版年·卷·期（页码）：2014·33·第三期（322-327）

摘要：

目的：探讨单肺通气（OLV）时不同潮气量（VT）对肺免疫功能、血流动力学和气体交换的影响。方法：将40例开胸手术患者随机分为2组，每组20例，分别以10 ml·kg^-1和5 ml·kg^-1的VT进行OLV，期间维持二氧化碳分压（PaCO₂）在正常水平。通气侧肺行纤维支气管镜肺泡灌洗，测定灌洗液中的细胞数、蛋白、肿瘤坏死因子（TNF）-α、白介素（IL）-8、IL-10、可溶性细胞间黏附分子（sICAM-1）以及弹性蛋白酶的含量。结果：所有患者均表现为促炎反应变量的增加。两组患者肺泡内细胞数、蛋白、白蛋白、IL-8、弹性蛋白酶和IL-10的时相变化在OLV后和术后均未见差异，但TNF-α和sICAM-1在5 ml·kg^-1组显著低于10 ml·kg^-1组。结论：机械通气（MV）可能导致通气侧肺的内皮损伤和促炎反应，OLV时减小VT可降低肺泡内TNF-α、sICAM-1的浓度。

Objective:To study the influence of one-lung ventilation(OLV) with different tidal volumes on pulmonary immune function, hemodynamics, and gas exchange.Methods:Forty patients undergoing open thoracic surgery were randomized to receive either mechanical ventilation(MV) with VT=10 ml·kg^-1(n=20) or VT=5 ml·kg^-1(n=20) adjusted to normal PaCO₂ during and after OLV. Fiberoptic bronchoalveolar lavage of the ventilated lung was performed, and cells, protein, tumor necrosis factor(TNF-α), interleukin(IL) -8, soluble intercellular adhesion molecule(slCAM-1), IL-10, and elastase were determined in the bronchoalveolar lavage. Data were analyzed by parametric or nonparametric tests as indicated. Results:In all patients,an increase of proinflammatory variables was found. The time courses of intra-alveolar cells, protein, albumin, IL-8, elastase, and IL-10 did not differ between the two groups after OLV and postoperatively. TNF-α and sICAM-1 concentrations were significantly smaller after OLV with VT=5ml·kg^-1. Conclusion:MV may induce epithelial damage and a proinflammatory response in the ventilated lung. Reduction of tidal volume during OLV may reduce alveolar concentrations of TNF-α and sICAM-1.

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