High tidal volume ventilation induces lung injury after hepatic ischemia-reperfusion
High tidal volume ventilation induces lung injury after hepatic ischemia-reperfusion
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DOI：
10.1152/ajplung.00151.2006
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发表时间：
2007-03-01
影响因子：
4.9
通讯作者：
Kurahashi, Kiyoyasu
中科院分区：
文献类型：
--
作者：
Ota, Shuhei;Nakamura, Kyota;Kurahashi, Kiyoyasu
缺血再灌注不仅损害受累器官，而且导致远端器官损伤。肝内流中断常发生在肝脏手术中。为了研究肝缺血再灌注对肺损伤的影响，并确定潮汐容量设置对肝缺血再灌注引起的肺损伤的贡献，我们研究了麻醉和机械通气的大鼠，肝血流短暂中断两次，持续15 min。在肝缺血再灌注后以及假手术后分别测定6 ml/kg （NC-LT）和24 ml/kg （NC-HT）两种潮气量，即6 ml/kg低潮气量（IR-LT）和24 ml/kg高潮气量（IR-HT）。IR-HT组和IR-LT组的全身血压逐渐下降，血浆tnf - α浓度显著升高。在四组中，只有IR-HT组发生肺损伤，通过肺干湿比增加，存在显著的组织病理学改变，如血管周围水肿和血管内白细胞聚集，以及支气管肺泡灌洗液tnf - α浓度增加来评估。此外，只有IR-HT组在6 h再灌注期间气道压力明显升高。这些结果提示肝脏缺血再灌注引起全身炎症，肝缺血再灌注后高潮气量通气可触发肺损伤。
Ischemia-reperfusion not only damages the affected organ but also leads to remote organ injuries. Hepatic inflow interruption usually occurs during hepatic surgery. To investigate the influence of liver ischemia-reperfusion on lung injury and to determine the contribution of tidal volume settings on liver ischemia-reperfusion-induced lung injury, we studied anesthetized and mechanically ventilated rats in which the hepatic inflow was transiently interrupted twice for 15 min. Two tidal volumes, 6 ml/kg as a low tidal volume (IR-LT) and 24 ml/kg as a high tidal volume (IR-HT), were assessed after liver ischemia-reperfusion, as well as after a sham operation, 6 ml/kg (NC-LT) and 24 ml/kg (NC-HT). Both the IR-HT and IR-LT groups had a gradual decline in the systemic blood pressure and a significant increase in plasma TNF-alpha concentrations. Of the four groups, only the IR-HT group developed lung injury, as assessed by an increase in the lung wet-to-dry weight ratio, the presence of significant histopathological changes, such as perivascular edema and intravascular leukocyte aggregation, and an increase in the bronchoalveolar lavage fluid TNF-alpha concentration. Furthermore, only in the IR-HT group was airway pressure increased significantly during the 6-h reperfusion period. These findings suggest that liver ischemia-reperfusion caused systemic inflammation and that lung injury is triggered when high tidal volume ventilation follows liver ischemia-reperfusion.