摘要
背景开胸手术需要长时间维持单肺通气（one-qung ventilation，OLV），这一过程可激活炎性细胞并释放大量炎性因子，导致肺部炎症反应及并发症。目的着重探讨OLV所致炎性因子释放的机制，保护性通气策略，促炎症消退等相关进展。内容OLV时，过度机械牵张刺激作用于肺细胞膜表面机械感受器，激活细胞内各种传导通路，导致各种致炎因子及炎症介质的上调表达。术中小潮气量、低气道压、低呼气末正压通气（end-expiratory positivepressure，PEEP）为策略的保护性通气模式的应用及吸入麻醉药、局部麻醉药、糖皮质激素等药物的使用可显著减少炎性因子的释放，减少胸科患者术后肺损伤的发病率。趋向内源性炎症消退机制及基因和生物靶向治疗已成为近年来研究炎症的新的热点。
Background A prolonged period of one-lung ventilation （OLV） is required during thoracic surgery which may activate cytokine release and cause lung inflammatory response. Objective This review will focus on recent advances in understanding OLV-induced cytokine release, protective ventilatory strategies and resolution of inflammation during OLV. Content During OLV, excessive mechanical stretch stimulation which acts on the mechanoreceptors in pulmonary alveoli cell membrane may activate various intracellular signalling pathway which causes increased expression of various proinflammatory cytokines and inflammatory mediators. Protective ventilatory strategies with low tidal volume, low airway pressure and positive end-expiratory pressure （PEEP） have been shown to reduce pulmonary and systemic cytokine releases. The application of inhalational anesthetics, local anesthetics, corticosteroids and other drugs can also significantly reduce the release of inflammatory cytokines and improve postoperative lung injury. Trend The mechanisms of resolution of endogenous inflammation, gene and targeted biological therapy have become new hot spot in the recent inflammation study.
出处
《国际麻醉学与复苏杂志》
CAS
2012年第4期258-262,共5页
International Journal of Anesthesiology and Resuscitation
关键词
单肺通气
炎症反应
保护性机械通气
促炎症消退
One-lung ventilation
Inflammatory response
Preventive mechanical ventilation
Resolution of inflammation
