肢体远隔缺血预处理对食管癌根治术患者单肺通气时的肺保护作用

Lung protection of remote limb ischemic preconditioning during one-lung ventilation in patients undergoing esophageal cancer resection

目的评价肢体远隔缺血预处理对食管癌根治术患者单肺通气时的肺保护作用。方法择期行食管癌根治术患者71例，年龄30～64岁，性别不限，体重指数15～28kg／m^2，ASA分级Ⅰ或Ⅱ级。采用随机数字表法，将患者分为2组：对照组（C组，n=34）和肢体远隔缺血预处理组（RLIP组，n=37）。RLIP组于单肺通气前将止血带捆绑于一侧上臂，给予3个循环的5min缺血5min再灌注的缺血预处理。分别于单肺通气前（T0）、单肺通气1h（T1）、单肺通气2h（T2）、恢复双肺通气20min（T3）、术后2h（T4）时采集桡动脉血样，进行血气分析，计算氧合指数（PaO2／FiO2）和肺泡-动脉氧分压差（A—aDO2），记录肺功能异常（PaO2／FiO2〈300mmHg）情况。并于T0、T2、T3、T4时采集桡动脉血样，测定血浆TNF—α、IL-6和IL-10的浓度。结果与c组比较，RLIP组T1,2时PaO2／FiO2升高，A—aDO2降低，T2-4时血浆TNF—α浓度降低（P〈0．05），血浆IL-6和IL-10的浓度和T。时肺功能异常率差异无统计学意义（P〉0．05）。结论肢体远隔缺血预处理对食管癌根治术患者单肺通气时具有肺保护作用，但临床意义不明显。

Objective To evaluate the lung protection of remote limb ischemic preconditioning during one-lung ventilation （OLV） in the patients undergoing esophageal cancer resection. Methods Seventyone patients of both sexes, aged 30-64 yr, with body mass index of 15-28 kg/m2 , of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective esophageal cancer resection, were randomly divided into control group （ group C, n = 34） and remote limb ischemic preconditioning group （ group RLIP, n= 37） using a random number table. Patients in group RLIP received three cycles of 5-min ische- mia/5-min reperfusion induced by a blood pressure cuff placed on one upper arm before OLV. Before OLV （T0）, at 1 and2 h ofOLV （Tx,2）, at 20 rain after re-expansion of the collapsed lung （T3）, and at 2 h after operation （T4） , blood samples were drawn from the radial artery for blood gas analysis, oxygenation index （PaO2/FiO2） and alveolar-arterial oxygen gradient （A-aDO2） were calculated. At To, T2, T3 and T4 , blood samples were collected from the radial artery for determination of plasma tumor necrosis factor-alpha （TNF-α）, interleukin-6 （IL-6）, and IL-10 concentrations. Results Compared with group C, PaO2/FiO2 was significantly increased, and A-aDO2was decreased at T1,2, the plasma TNF-α concentrations were decreased at T2-4 （P〈0.05） , and no significant change was found in the plasma IL-6 and IL-10 concentrations and rate of abnormal pulmonary function at T1-4 in group RLIP （P〉0.05）. Conclusion Although remote limb ischemic preconditioning can produce lung protection during OLV in the patients undergoing esophageal cancer resection, it provides no clinical significance.