Voigtsberger Stefanie, Lachmann Robert A, Leutert Anik C, Schläpfer Martin, Booy Christa, Reyes Livia, Urner Martin, Schild Julia, Schimmer Ralph C, Beck-Schimmer Beatrice
Institute of Anesthesiology, University of Zurich, Zurich, Switzerland.
Anesthesiology. 2009 Dec;111(6):1238-48. doi: 10.1097/ALN.0b013e3181bdf857.
Acute lung injury is a common complication in critically ill patients. Several studies suggest that volatile anesthetics have immunomodulating effects. The aim of the current study was to assess possible postconditioning with sevoflurane in an in vivo model of endotoxin-induced lung injury.
Rats were anesthetized, tracheotomized, and mechanically ventilated. Lipopolysaccharide (saline as control) was administered intratracheally. Upon injury after 2 h of propofol anesthesia, general anesthesia was continued with either sevoflurane or propofol for 4 h. Arterial blood gases were measured every 2 h. After 6 h of injury, bronchoalveolar lavage was performed and lungs were collected. Total cell count, albumin content, concentrations of the cytokines cytokine-induced neutrophil chemoattractant-1 and monocyte chemoattractant protein-1, and phospholipids were analyzed in bronchoalveolar lavage fluid. Expression of messenger RNA for the two cytokines and for surfactant protein B was determined in lung tissue. Histopathologic examination of the lung was performed.
Significant improvement of the ratio of oxygen tension to inspired oxygen fraction was shown with sevoflurane (mean + or - SD: 243 + or - 94 mmHg [32.4 kPa]) compared with propofol (88 + or - 19 mmHg [11.7 kPa]). Total cell count representing effector cell recruitment as well as albumin content as a measure of lung permeability were significantly decreased in the sevoflurane-lipopolysaccharide group compared with the propofol-lipopolysaccharide group in bronchoalveolar lavage fluid. Expression of the cytokines protein in bronchoalveolar lavage fluid as well as messenger RNA in lung tissue was significantly lower in the sevoflurane-lipopolysaccharide group compared with the propofol-lipopolysaccharide group.
Postconditioning with sevoflurane attenuates lung damage and preserves lung function in an in vivo model of acute lung injury.
急性肺损伤是危重症患者常见的并发症。多项研究表明，挥发性麻醉药具有免疫调节作用。本研究旨在评估在脂多糖诱导的肺损伤体内模型中，七氟醚是否具有可能的后适应作用。
将大鼠麻醉、气管切开并进行机械通气。经气管内给予脂多糖（以生理盐水作为对照）。在丙泊酚麻醉2小时后造成损伤，随后用七氟醚或丙泊酚继续全身麻醉4小时。每2小时测量动脉血气。损伤6小时后，进行支气管肺泡灌洗并采集肺组织。分析支气管肺泡灌洗液中的总细胞计数、白蛋白含量、细胞因子诱导的中性粒细胞趋化因子-1和单核细胞趋化蛋白-1的浓度以及磷脂。测定肺组织中这两种细胞因子和表面活性蛋白B的信使核糖核酸表达。对肺进行组织病理学检查。
与丙泊酚组（88±19 mmHg [11.7 kPa]）相比，七氟醚组（均值±标准差：243±94 mmHg [32.4 kPa]）的氧分压与吸入氧分数之比有显著改善。在支气管肺泡灌洗液中，与丙泊酚-脂多糖组相比，七氟醚-脂多糖组中代表效应细胞募集的总细胞计数以及作为肺通透性指标的白蛋白含量均显著降低。与丙泊酚-脂多糖组相比，七氟醚-脂多糖组支气管肺泡灌洗液中细胞因子蛋白的表达以及肺组织中信使核糖核酸的表达均显著降低。
在急性肺损伤体内模型中，七氟醚后适应可减轻肺损伤并保留肺功能。
