肢体远隔缺血预处理减轻单肺通气时患者的肺损伤

Limb remote ischemic preconditioning attenuates lung injury in patients during one-lung ventilation

目的探讨远隔缺血预处理(RIPC)对全身麻醉下开胸手术患者单肺通气(OLV)时肺损伤的影响。方法择期行开胸食管癌根治术患者80例,采用随机数字表法分为2组(n=40):对照组(C组)和肢体RIPC组(RIPC组)。于OLV即刻(T1)、30min(T2)、1h(T3)、2h(T4)时采集桡动脉血样行血气分析,计算氧合指数(OI)、呼吸指数(RI)和PaO2/PAO2,采用酶联免疫吸附法测定血浆TNF-α、IL-1β和IL-10的水平,收集呼出气冷凝液,测定pH值。结果与C组比较,RIPC组T2~T4时OI升高,RI降低,PaO2/PAO2升高,T3~T4时,血浆TNF-α和IL-1β水平降低,呼出气冷凝液pH值升高,T4时血浆IL-10水平升高(P<0.05)。结论 RIPC可抑制开胸手术患者OLV时的炎性反应,减轻气道酸化,从而减轻肺损伤。

Objective To investigate the effect of remote ischemic preconditioning（RIPC）on the lung injury during one-lung ventilation（OLV）in the patients undergoing thoracic surgery.Methods Eighty patients scheduled for elective radical operation for esophageal cancer,were randomly divided into 2groups（n=40each）using a random number table：control group（group C）and group RIPC.At 0（T1）,30min（T2）,1h（T3）and 2h（T4）of OLV,blood samples were obtained from the radial artery for blood gas analysis and determination of plasma concentrations of tumor necrosis factor-α（TNF-α）,interleukin-1β（IL-1β）and IL-10.Oxygenation index（OI）,respiratory index（RI）and PaO2/PAO2 were calculated.Exhaled breath condensate was collected and the pH value was measured.Results Compared with group C,Oxygenation index was significantly increased,and respiratory index was decreased at T2-T4,the plasma concentrations of TNF-αand IL-1βwere decreased,and the pH value of exhaled breath condensate was increased at T3-T4,and the plasma concentration of IL-10 was increased at T4 in group RIPC.Conclusion RIPC can inhibit inflammatory responses and reduce airway acidification,thus attenuating the lung injury during OLV in the patients undergoing thoracic surgery.