Systemic and alveolar inflammatory response in the dependent and nondependent lung in patients undergoing lung resection surgery A prospective observational study
Systemic and alveolar inflammatory response in the dependent and nondependent lung in patients undergoing lung resection surgery A prospective observational study
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DOI：
10.1097/eja.0000000000000233
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发表时间：
2015-12-01
影响因子：
3.6
通讯作者：
Vara, Elena
中科院分区：
文献类型：
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作者：
de la Gala, Francisco;Pineiro, Patricia;Vara, Elena
背景在单肺通气期的肺切除手术中，对支气管肺泡灌洗液(BAL)中炎症介质的测量显示了强烈的局部肺反应。在这一过程中，每个肺在炎症反应中的作用从未被研究过。目的：本研究的主要目的是通过测量BAL中的炎症标志物来比较依赖肺和非依赖肺的炎症反应。我们的次要目标是评估有和没有术后肺部并发症(PPC)的患者这些炎症介质的行为。设计一项前瞻性的观察性研究。在一所大学医院的麻醉科。患者连续46例接受肺切除手术。干预(S)在开始OLV前10分钟和OLV结束时(一旦建立双肺通气)采集依赖和非依赖肺的BAL样本。主要指标检测OLV前后双肺组织细胞因子[白介素1、白介素2、白介素6、白介素10、肿瘤坏死因子α、一氧化氮、一氧化碳、基质金属蛋白酶2]的浓度。结果在BAL液中，除IL-10外，所有生物标志物在OLV结束时均显著高于OLV前(P<；0.05)，无论是依赖肺还是非依赖肺。测量到的生物标志物在两个肺中的增加是相似的。8例患者发生PPC。发生PPC的患者在OLV前后非依赖肺BAL中的肿瘤坏死因子-α(P<；0.05)水平高于无PPC的患者。发生PPC的患者依赖侧肺组织中的MMP2水平较无PPC的患者低(P<0.05)。结论在肺切除手术中，双肺的炎症反应相似。非依赖型肺组织中肿瘤坏死因子-α水平升高幅度较大，而依赖型肺组织中基质金属蛋白酶-2浓度升高幅度较小，可能增加发生PPC的易感性。
BACKGROUND Measurement of inflammatory mediators in bronchoalveolar lavage (BAL) during lung resection surgery with periods of one-lung ventilation (OLV) has revealed an intense local pulmonary response. The role of each lung in the inflammation that occurs during this procedure has never been investigated.OBJECTIVE(S) The primary objective of our study was to compare the inflammatory response in the dependent lung with that of the nondependent lung by measuring inflammatory markers in BAL. Our secondary objective was to assess the behaviour of these inflammatory mediators in patients with and without postoperative pulmonary complications (PPCs).DESIGN A prospective, observational study.SETTING Department of Anaesthesiology in a university hospital.PATIENTS Forty-six consecutive patients undergoing lung resection surgery.INTERVENTION(S) BAL samples were taken from dependent and nondependent lung 10 min before initiating OLV and at the end of OLV (once two-lung ventilation was established). All patients were followed up until 30 days after surgery.MAIN OUTCOME MEASURES The concentration of cytokines [interleukin (IL)-1, IL-2, IL-6, IL-10, tumour necrosis factor-alpha (TNF-alpha)], nitric oxide, carbon monoxide and matrix metalloproteinase 2 (MMP-2) was analysed in both lungs before and after OLV. PPCs were recorded.RESULTS In BAL fluid, all measured biomarkers, apart from IL-10, were significantly greater (P < 0.05) at the end of OLV than those obtained before OLV, both for the dependent and nondependent lung. The increase in measured biomarkers was similar in both lungs. Eight patients developed PPC. Patients who developed PPC had higher levels of TNF-alpha (P< 0.05) in BAL from the nondependent lung before and after OLV than patients who did not have PPC. Patients who developed PPC had a smaller increase in MMP-2 levels (P< 0.05) in the dependent lung than patients who did not have PPC.CONCLUSION In lung resection surgery, the inflammatory response is similar in both lungs. However, the greater increase in TNF-alpha levels in the nondependent lung and the smaller increase of MMP-2 concentration in the dependent lung may increase the susceptibility to develop PPC.