远端缺血预处理对食管癌根治术单肺通气患者肺功能及血清炎症因子的影响

Effect of remote ischemic preconditioning on lung function and serum inflammatory factors in patients with esophageal cancer after radical operation with one lung ventilation

目的探讨远端缺血预处理对食管癌根治术单肺通气患者肺功能及血清炎症因子的影响。方法将60例行食管癌根治术的患者随机分为对照组和观察组各30例,对照组不行远端缺血预处理,观察组行远端缺血预处理,分别于气管插管后5 min(t1)、单肺通气后60 min(t2)、恢复双肺通气后10 min(t3)、手术结束时(t4)抽取患者静脉血、动脉血,监测患者的血气指标、呼吸动力学指标、炎症因子指标。结果 t2时,2组p(O2)、PA-a(DO2)、Qs/Qt均明显高于t1时(P均<0.05),但观察组均明显低于对照组(P均<0.05);2组OI均明显低于t1时(P均<0.05),但观察组明显高于对照组(P<0.05)。t3、t4时,2组p(O2)、PA-a(DO2)、Qs/Qt均明显低于t2时(P均<0.05),且观察组明显低于对照组(P均<0.05);2组OI均明显高于t2时(P均<0.05),且观察组明显高于对照组(P<0.05)。t2、t3、t4时,2组Cdyn均明显低于t1时(P均<0.05),pplat、ppeak明显高于t1时(P均<0.05),2组间Cdyn、pplat、ppeak比较差异均无统计学意义(P均>0.05)。t2时,2组TNF-α、IL-6、IL-1水平均明显高于t1时(P均<0.05),但观察组明显低于对照组(P均<0.05)。t3、t4时,2组TNF-α水平均明显低于t2时(P均<0.05),且观察组明显低于对照组(P均<0.05);对照组IL-6、IL-1水平继续升高(P均<0.05),而观察组IL-6、IL-1水平明显下降(P均<0.05),随着时间的推移基本恢复至t1水平。结论远端缺血预处理能有效减轻食管癌根治术单肺通气时肺组织缺血/再灌注损伤导致的炎症反应,降低肺损伤程度,改善及促进患者肺功能的恢复。

Objective It is to investigate the influence of remote ischemic preconditioning on lung function and serum inflammatory factors in patients with esophageal cancer after radical operation with one lung ventilation.Methods 60 patients with esophageal cancer were randomly divided into the control group and the observation group with 30 cases in each group.Patients were treated with remote ischemic preconditioning in the observation group and with non in control group.Venous blood and arterial blood samples in patients were collected for blood gas indexes,respiratory dynamics indexes and inflammatory factors at 5min（t1）,60 min after one lung ventilation（t2）,10 min after one lung ventilation（t3）,after the recovery of double lung ventilation 10min（t3）,and the end of operation（t4）.Results At t2,the p（O2）,PA-a（DO2）,Qs/Qt of 2groups were significantly higher than t1（all P 〈 0.05）,but those of the observation group was significantly lower than the control group（all P 〈 0.05）; the OI of 2 groups were significantly lower than t1（all P 〈 0.05）,but those of the observation group was significantly higher than the control group（all P 〈 0.05）.At t3 and t4,the p（O2）,PA-a（DO2）,Qs/Qt of 2groups were significantly lower than t2（all P 〈 0.05）,and those of the observation group was significantly lower than the control group（all P 〈 0.05）; the OI of 2 groups were significantly higher than t2（all P 〈 0.05）,and those of the observation group was significantly higher than the control group（all P 〈 0.05）.At t2,t3,t4,the Cdyn of 2 groups were significantly lower than t1（all P 〈 0.05）,and ppeakand pplatwere significantly higher than t1（all P 〈 0.05）,there was no significant difference in Cdyn,pplat,and ppeakbetween the 2 groups（P 〉 0.05）.At t2,the levels of IL-1,IL-6 and TNF-α in the 2groups were all significantly higher than t1（all P 〈 0.05）,but those of the observation group was significantly lower than the control group（all P 〈 0.05）.At t3,t4,the TNF-α levels of 2 groups were significantly lower than t2（all P 〈 0.05）,and that of the observation group was significantly lower than the control group（P 〈 0.05）; the levels of IL-6 and IL-1 in thecontrol group were increased（all P 〈 0.05）,but the levels of IL-6 and IL-1 in the observation group were significantly decreased（all P 〈 0.05）,and basically restored to the level of t1 with the passage of time.Conclusion Distal ischemic preconditioning can effectively reduce the inflammatory response induced by ischemia / reperfusion injury in lung tissue during one lung ventilation in patients with esophageal cancer,reduce the degree of lung injury,improve and promote the recovery of lung function in patients.