The effect of one-lung ventilation upon pulmonary inflammatory responses during lung resection
The effect of one-lung ventilation upon pulmonary inflammatory responses during lung resection
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DOI：
10.1007/s00540-011-1100-0
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发表时间：
2011-04-01
影响因子：
2.8
通讯作者：
Inada, Eiichi
中科院分区：
文献类型：
--
作者：
Sugasawa, Yusuke;Yamaguchi, Keisuke;Inada, Eiichi
单肺通气（OLV）常用于胸外科手术。使用支气管肺泡灌洗液分析的临床研究表明，OLV可诱导通气依赖肺的肺部炎症反应。然而，很少有临床研究将依赖肺与塌陷的非依赖肺的炎症反应进行比较。在这里，我们使用支气管镜显微取样法从每个肺中获取上皮衬里液（ELF），然后比较胸外科手术中依赖肺和非依赖肺的炎症反应。对20名成年患者进行了研究。所有患者均采用OLV进行胸外科手术。全静脉麻醉采用异丙酚和瑞芬太尼。采用双腔气管内插管进行OLV。使用支气管镜显微取样法从每个肺中获得ELF。采用ELISA法检测OLV前后炎症介质、肿瘤坏死因子α、白细胞介素(IL)-1 β、IL-6、IL-8、IL-10、IL-12p70的ELF水平。手术结束时，依赖肺和非依赖肺中IL-1 β、IL-6和IL-8的ELF水平与基线水平相比显著升高（p < 0.05）。手术结束时，依赖肺中IL-6 ELF水平明显高于非依赖肺（p = 0.019）。胸外科手术中依赖肺和非依赖肺的单肺通气诱导支气管上皮的炎症反应。此外，这些炎症反应在依赖肺中比在非依赖肺中更增强。
One-lung ventilation (OLV) is commonly used during thoracic surgery. Clinical studies using bronchoalveolar lavage fluid analysis have demonstrated that OLV induces pulmonary inflammatory reactions in the ventilated dependent lung. However, few clinical studies have investigated such inflammatory reactions in the dependent lung compared with the collapsed nondependent lung. Here we used a bronchoscopic microsampling method to obtain epithelial lining fluid (ELF) from each lung, and then compared the inflammatory reactions in the dependent lung and the nondependent lung during thoracic surgery.Twenty adult patients were studied. All patients underwent thoracic surgery using OLV. Propofol and remifentanil were used for total intravenous anesthesia. A double-lumen endotracheal tube was used to perform OLV. ELF was obtained from each lung using the bronchoscopic microsampling method. ELF levels of inflammatory mediators, tumor necrosis factor alpha, interleukin (IL)-1 beta, IL-6, IL-8, IL-10, and IL-12p70 were measured using ELISA before and after OLV.ELF levels of IL-1 beta, IL-6, and IL-8 were significantly increased in the dependent lung and the nondependent lung at the end of surgery compared with their baseline levels (p < 0.05). ELF level of IL-6 was significantly higher in the dependent lung than in the nondependent lung at the end of surgery (p = 0.019).One-lung ventilation induced inflammatory responses of the bronchial epithelia in the dependent lung and the nondependent lung during thoracic surgery. In addition, these inflammatory responses were more augmented in the dependent lung than in the nondependent lung.