摘要
目的探讨单肺通气（OLV）前间断通气对非通气侧肺组织缺氧诱导因子1α（HIF-1α）及靶基因血红素加氧酶-1（HO-1）的影响。方法选择择期全麻下行肺癌根治术的老年患者40例,男19例,女21例,年龄65~80岁,BMI 18~25kg/m2,ASAⅡ或Ⅲ级。采用随机数字表法,将患者均分为两组：对照组（C组）和间断通气预处理组（Y组）。两组麻醉诱导后行气管插管,机械通气。两组气管插管成功后立即改为OLV,C组非通气侧肺不做任何处理;Y组非通气侧肺用负压吸引器（压力0.06 MPa）吸引10s后开放于空气,5min后改为双肺通气,5min后再次改为OLV,重复上述操作,如此3个循环后改为双肺通气。于手术进胸后OLV即刻（T1）、OLV 60min（T2）和病变组织切除即刻（T3）分别切取肿瘤周边约2cm需手术一并切除的肺组织,一份经液氮保存,Western blot法检测HIF-1α及HO-1表达;余下肺组织置于多聚甲醛溶液中待检,光镜下观察肺组织损伤程度,并进行肺损伤评分。结果与T1时比较,T2、T3时两组PaO2明显降低（P〈0.05）,T2时Y组HIF-1α表达明显升高,T3时两组HIF-1α和HO-1表达明显升高（P〈0.05）;与T2时比较,T3时两组HIF-1α表达明显升高,Y组HO-1表达明显升高（P〈0.05）;T2、T3时Y组HIF-1α表达明显高于C组,T3时Y组HO-1表达明显高于C组（P〈0.05）。与T1时比较,T3时两组肺损伤评分明显升高（P〈0.05）;T3时Y组肺损伤评分明显低于C组（P〈0.05）。结论单肺通气前间断通气可减轻非通气侧肺塌陷期间肺损伤程度,其机制可能与增强塌陷侧肺组织HIF-1α及其靶基因HO-1表达有关。
Objective To investigate the effect of intermittent ventilation preconditioning before one lung ventilation on hypoxic induced factor la（HIF-1a） and hemeoxygenase-l（HO-1） in the elderly patients undergoing the radical surgery for lung carcinoma.Methods Forty patients, 19 males and 21 females, aged 65-80 years, ASA Ⅱ or Ⅲ, with BMI 18-25 kg/m2, scheduled for radical surgery of lung carcinoma, were randomly divided into two groups（n=20） .. the control group （group C）and the intermittent ventilation preconditioning group （group Y）. After induction of anesthesia, all patients were intubated and then mechanically ventilated. Patients in the group C received OLV after the intubation. Patients in group Y also received OLV immediately after intubation, but the nonventilated lung were sucked and opened to the air for 5 minutes before returning to the two lung ventilation. This process was repeated for three times followed by OLV. The expression of HIF-1a and HO-1 were detected by western blot at the following time points： the beginning of OLV（T1 ）, OLV 60 min（T2 ）, and the resection of tumor tissue（T3 ）. The injury of lungs was evaluated under the microscope.Results Compared with T1, PaO2 was significantly decreased at T2 ,T3 in both groups, the expression of HIF-1a in group Y were increased at T2, while the expression of HIF-1a and HO-1 in both groups were increased at Ta （P〈0. 05）. When compared with Ta the expression of HIF-I~ in both groups were increased at T3, while the expression of HO-1 in group Y were increased at T3 （P〈0.05）. Compared with group C, the expression of HIF-1a in group Y were increased at T2, T3, while the expression of HO-1 in group Y were increased at Ta （P〈0.05）. Compared with T1, the injury scores in both groups were increased at Ta, while the injury scores in group Y at T3 were lower than that in group C （P〈0. 05）.Conclusion The impairment of the independent lung tissue could be alleviated by the intermittent ventilation precondition
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2016年第1期10-14,共5页
Journal of Clinical Anesthesiology
基金
河南省科技厅项目(122300410068)
关键词
间断通气
呼吸
单肺通气
缺氧
Intermittent ventilation Respiration one lung ventilatiom Hypoxia
