摘要
目的探讨单肺通气时间对食管癌根治术后肺泡灌洗液中肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)值和血清炎症指标及早期肺部感染的影响。方法选择限期行胸腹腔镜食管癌根治术患者90例,按胸腔镜下单肺通气时间分为T1组(0.5~1.5 h)、T2组(1.5~2.5 h)和T3组(>2.5 h),术后立即取左侧通气肺和右侧萎陷肺纤支镜灌洗液,ELISA法测定IL-6、TNF-α水平;分别在术后1、3、5 d检测患者体内降钙素原(PCT)、C反应蛋白(CRP)和白细胞计数(WBC)情况,观察术后3 d内各组患者肺部感染的发生率。结果各组右侧萎陷肺IL-6值均较左侧通气肺升高,T2、T3组右侧萎陷肺TNF-α值较左侧通气肺高,差异有统计学意义(P<0.05)。右侧萎陷肺组间比较,随单肺通气时间延长,TNF-α、IL-6值逐渐升高,各组间差异有统计学意义(P<0.05)。左肺通气肺组间比较,随单肺通气时间延长,IL-6值逐渐升高,差异有统计学意义(P<0.05),T3组TNF-α值较T1、T2组升高,差异有统计学意义(P<0.05)。T3组患者术后第3、5 d PCT值均较T1、T2组升高(P<0.05),而三组患者各时点CRP、WBC差异无统计学意义。T3组患者术后3 d内肺部感染发生率明显高于T1组(P<0.05)。结论随着单肺通气时间的延长,肺组织局部及全身炎症介质释放增多,肺部感染的发生几率越高。
Objective To investigate the effects of one-lung ventilation time on the concentration of tumor necrosis factor （TNF）-a and interleukin （IL）-6 in the bronchoalveolar lavage fluid （BALF）, serum inflammatory markers and early pulmonary infection after radical resection of esophageal cancer. Methods Ninety patients with thoracoscope and laparoscopic radical resection of esophageal carcinoma were chosen. According to the thoracoscope operation time, the patients were divided into 3 groups including a T1 （0.5-1.5 hours） group, a T2 （1.5-2.5 hours） group and a T3 （〉2.5 hours） group. Immediately after the operation, the ventilated and collapsed BALF were taken. Enzyme-linked immunosorbent assay （ELISA） method was used to determine the concentration of IL-6 and tumour necrosis TNF-u. The concentrations ofprocalcitonin （PCT）, C-reactive protein （CRP）, and white blood cell （WBC） were measured on the first, third, fifth day after operation. The incidence of pulmonary infection was observed within 3 days after operation. Result The IL-6 values of the right collapsed lung in all groups were higher than those in the left ventilated lung. The TNF-a value of the right collapsed lung in the T2 group and T3 group was higher than that in the left ventilated lung （P〈0.05）. Compared with in the right collapsed lung, the TNF-a and IL-6 values gradually increased with the the duration of one-lung ventilation （P〈O.05）. Compared with the left ventilated lung groups,the IL-6 value increased gradually with the duration of one-lung ventilation time （P〈0.05）. The TNF-a value of the T3 group was higher than that of the T 1 and T2 groups （P〈0.05）. The PCT value of the T3 group was higher than that of the T1 group and T2 group on the third, fifth day after operation （P〈0.05）. But there was no significant difference in CRP and WBC among the three groups at different time points. The incidence of pulmonary infection in the T3 group was significantly higher than that in th
作者
周瑞琴
叶琳
李林峻
张诚
吴庆琛
ZHOU Ruiqin;YE Lin;LI Linjun;ZHANG Cheng;WU Qingchen(Department of Cardiothoracic Surgery,The First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,P.R.China)
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2018年第10期855-859,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
重庆市科研项目(2012-015)
关键词
食管癌
单肺通气
白细胞介素6
肿瘤坏死因子α
降钙素原
肺部感染
Esophageal cancer
one-lung ventilation
interleukin-6
tumor necrosis factor-α
procalcitonin
pulmonary infection
