Cheng Ya-Jung, Chan Kuang-Cheng, Chien Chiang-Ting, Sun Wei-Zen, Lin Chen-Jung
Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
J Thorac Cardiovasc Surg. 2006 Sep;132(3):513-8. doi: 10.1016/j.jtcvs.2006.03.060.
Resuming 2-lung ventilation from 1-lung ventilation might induce a re-expansion and reoxygenation effect. The oxidative stress during 1-lung ventilation/2-lung ventilation has not been studied, although severe complications, such as re-expansion pulmonary edema, were reported. Reactive oxygen species production and total antioxidant status assay levels were measured in this study during 1-lung ventilation/2-lung ventilation. The effects on extravascular lung water, cardiac output, and intrathoracic blood volume were also studied by using the Pulsion PiCCO system.
Twenty patients undergoing 1-lung ventilation/2-lung ventilation (>60 minutes) for video-assisted thoracoscopic surgery with minimal lung injuries were included in this study. Reactive oxygen species production was measured by means of lucigenin (detecting superoxide mainly) and luminol (detecting H2O2 and HOCl mainly) chemiluminescence. Reactive oxygen species production, total antioxidant status assay (by using the Randox TAS kit), extravascular lung water, cardiac output, and intrathoracic blood volume values were measured before 1-lung ventilation (T1), before resuming 2-lung ventilation (T2), 5 minutes after 2-lung ventilation (T3), and 30 minutes after 2-lung ventilation (T4).
One-lung ventilation time was 118 +/- 33 minutes. Lucigenin chemiluminescence (but not luminol chemiluminescence) increased significantly at T3 and T4. Total antioxidant status decreased nonsignificantly. Extravascular lung water, intrathoracic blood volume, and permeability index values changed nonsignificantly after 2-lung ventilation. Cardiac output increased significantly at T4, and there is a negative correlation between cardiac output and extravascular lung water (r = -0.431, P < .005).
Resuming 2-lung ventilation induces a massive superoxide production. Comparable extravascular lung water and intrathoracic blood volume and a nonsignificant decrease of total antioxidant status indicate adequate antioxidant capacity to counteract it. Severe oxidative injuries after 1-lung ventilation/2-lung ventilation should be considered in patients without adequate antioxidative capacity, such as those with cancer and trauma.
从单肺通气恢复双肺通气可能会引发再膨胀和再氧合效应。尽管有报道称存在诸如再膨胀性肺水肿等严重并发症，但单肺通气/双肺通气期间的氧化应激尚未得到研究。本研究在单肺通气/双肺通气期间测量了活性氧生成量和总抗氧化状态测定水平。还使用脉搏指示连续心输出量（Pulsion PiCCO）系统研究了其对血管外肺水、心输出量和胸腔内血容量的影响。
本研究纳入了20例接受单肺通气/双肺通气（>60分钟）的电视辅助胸腔镜手术患者，这些患者的肺损伤最小。通过光泽精（主要检测超氧化物）和鲁米诺（主要检测过氧化氢和次氯酸）化学发光法测量活性氧生成量。在单肺通气前（T1）、恢复双肺通气前（T2）、双肺通气后5分钟（T3）和双肺通气后30分钟（T4）测量活性氧生成量、总抗氧化状态测定（使用朗道克斯总抗氧化能力（Randox TAS）试剂盒）、血管外肺水、心输出量和胸腔内血容量值。
单肺通气时间为118±33分钟。光泽精化学发光（而非鲁米诺化学发光）在T3和T4时显著增加。总抗氧化状态无显著下降。双肺通气后血管外肺水、胸腔内血容量和通透性指数值无显著变化。心输出量在T4时显著增加，且心输出量与血管外肺水之间存在负相关（r = -0.431，P <.005）。
恢复双肺通气会引发大量超氧化物生成。相当的血管外肺水和胸腔内血容量以及总抗氧化状态的无显著下降表明有足够的抗氧化能力来抵消它。对于没有足够抗氧化能力的患者，如癌症和创伤患者，应考虑单肺通气/双肺通气后发生严重氧化损伤的情况。
