摘要
目的评价单肺通气(OLV)时无呼吸性气流通气(AOI)对患者非通气侧肺泡巨噬细胞(AM)表型转化的影响。方法选择择期行胸腔镜下肺叶切除术的患者60例,性别不限,年龄40~64岁,体重45~85 kg,采用电脑随机数字表法分为2组(n=30):观察组和对照组。OLV开始时观察组患者非通气侧肺给予3 L/min的AOI,对照组患者非通气侧肺不给予AOI。分别于术前、麻醉诱导后即刻、OLV开始后30 min、1 h及2 h时采集桡动脉血样,进行血气分析,计算氧合指数(OI)。OLV开始后2 h时,留取病灶周边正常的肺组织,进行HE染色并评估肺损伤评分;收集支气管肺泡灌洗液(BALF),采用流式细胞术分选AM并测定其凋亡率及细胞内Ca^(2+)和M1型AM标志物ROS水平,采用ELISA法检测BALF中M1型AM标志物诱导型一氧化氮合酶(iNOS)、IL-6、TNF-α和M2型AM标志物精氨酸酶1(Arg-1)和IL-10浓度。结果与对照组比较,观察组SpO_(2)、PaO_(2)和OI升高,PaCO_(2)和肺损伤评分降低,AM存活率升高,早期和晚期凋亡率降低,BALF中iNOS、IL-6和TNF-α浓度降低,Arg-1和IL-10浓度升高,AM内ROS水平降低,Ca^(2+)水平升高(P<0.05)。结论胸腔镜下肺叶切除术患者OLV时,非通气侧肺实施AOI减轻非通气侧肺损伤的机制可能与其促使AM由M1型向M2型转化,抑制炎性反应有关。
Objective To evaluate the effect of apneic oxygen insufflation(AOI)on phenotypic transformation of alveolar macrophage(AM)in the non-ventilated lung during one-lung ventilation(OLV).Methods A total of 60 patients of either sex,aged 40-64 yr,weighing 45-85 kg,undergoing elective thoracoscopic lobectomy,were recruited and divided into 2 groups using a computer-generated table of random numbers:test group and control group,with 30 cases in each group.At the beginning of OLV,the non-ventilated lung received 3 L/min of AOI in test group and no AOI in control group.Radial artery blood samples were collected for blood gas analysis before operation,immediately after anesthesia induction,30 min,1 h and 2 h after the start of OLV,and oxygenation index(OI)was calculated.The resected normal lung tissues around the lung lobe were excised at 2 h after the start of OLV for microscopic examination of the pathological changes after HE staining,and the lung injury score was assessed.Bronchoalveolar lavage fluid(BALF)was collected at 2 h after the start of OLV,AM was sorted by flow cytometry,and the apoptotic rate was calculated.The levels of intracellular Ca^(2+) and reactive oxygen species(ROS,a marker of M1 AM phenotype)in cells were determined.The concentrations of M1 phenotype AM markers inducible nitric oxide synthase(iNOS),interleukin 6(IL-6),and tumor necrosis factor alpha(TNF-α)and of M2 phenotype AM markers arginase 1(Arg-1)and interleukin 10(IL-10)in BALF were measured by enzyme-linked immunosorbent assay.Results Compared with control group,SpO_(2),PaO_(2) and OI were significantly increased,PaCO_(2) and lung injury score were decreased,the survival rate of AM was increased,the apoptotic rate in the early and late stages was decreased,the concentrations of iNOS,IL-6 and TNF-αin BALF were decreased,and the concentrations of Arg-1 and IL-10 in BALF were increased,the level of ROS in AM was decreased,and the level of Ca^(2+) in AM was increased in test group(P<0.05).Conclusions The mechanism by which implementing AOI in t
作者
李宁
周俊辉
张会
Li Ning;Zhou Junhui;Zhang Hui(Department of Anesthesiology and Perioperative Medicine,Henan Provincial People′s Hospital,Zhengzhou University People′s Hospital,Zhengzhou 450003,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2022年第3期323-327,共5页
Chinese Journal of Anesthesiology
基金
河南省医学科技攻关计划-联合共建项目(2018020564)。
关键词
单肺通气
巨噬细胞
肺泡
表型
胸外科手术
无呼吸性气流通气
One lung ventilation
Macrophages,alveoli
Phenotype
Thoracic surgery
Apneic oxygen insufflation
