Department of Anesthesia and Intensive Care, St Olavs Hospital, Trondheim, Norway.
Shock. 2010 Nov;34(5):517-24. doi: 10.1097/SHK.0b013e3181dfc430.
Today, there is no continuous monitoring of the bronchial epithelial lining fluid. This study used microdialysis as a method of continuous monitoring of early lung cytokine response secondary to intestinal ischemia-reperfusion in pigs. The authors aimed to examine bronchial microdialysis for continuous monitoring of IL-1β, TNF-α, IL-8, and fluorescein isothiocyanate Dextran 4,000 Da (FD-4). The superior mesenteric artery was cross-clamped for 120 min followed by 240 min of reperfusion (ischemia group, n = 8). Four sham-operated pigs served as controls. The pigs were anesthetized and normoventilated (peak inspiratory pressure, <20 cm H2O; positive end-expiratory pressure, 7 cm H2O). Samples from bronchial and luminal intestinal and arterial microdialysis catheters (flow-rate of 1 μL/min) were collected during reperfusion in 60-min fractions. Samples were analyzed for TNF-α, IL-1β, IL-8, and FD-4. Data are presented as median (interquartile range). A lung biopsy was collected at the end of the experiment. During reperfusion, there was an increase in bronchial concentrations of both IL-8 (3.70 [1.47-8.93] ng/mL per h vs. controls, 0.61 [0.47-0.91] ng/mL per h; P < 0.001) and IL-1β (0.32 [0.05-0.56] ng/mL per h vs. controls, 0.07 [0.04-0.10] ng/mL per h; P = 0.008). In the intestinal lumen, IL-8 was increased in the ischemia group (6.33 [3.13-9.23] ng/mL per h vs. controls, 0.89 [0.21-1.86] ng/mL per h; P < 0.001). The FD-4 did not differ between groups. Pulmonary vascular resistance and pulmonary shunt increased versus controls. During reperfusion, PaO2/FiO2 ratio decreased in the ischemia group. Histology was normal in both groups. Bronchial microdialysis detects altered levels of cytokines in the epithelial lining fluid and can be used for continuous monitoring of the immediate local lung cytokine response secondary to intestinal ischemia-reperfusion.
目前，尚未对支气管上皮衬液进行连续监测。本研究采用微透析技术，作为连续监测猪肠道缺血再灌注后早期肺细胞因子反应的一种方法。作者旨在通过支气管微透析连续监测白细胞介素-1β（IL-1β）、肿瘤坏死因子-α（TNF-α）、白细胞介素-8（IL-8）和异硫氰酸荧光素右旋糖酐 4000（FD-4）。夹闭肠系膜上动脉 120 分钟，再灌注 240 分钟（缺血组，n=8）。4 头假手术猪作为对照。猪全麻，正压通气（吸气峰压<20cmH2O；呼气末正压 7cmH2O）。再灌注期间，以 60 分钟为间隔，从支气管、肠腔和动脉微透析导管中采集样本（流速为 1μL/min）。对 TNF-α、IL-1β、IL-8 和 FD-4 进行分析。数据以中位数（四分位距）表示。实验结束时采集肺活检标本。再灌注期间，支气管 IL-8 浓度升高（3.70[1.47-8.93]ng/mL/h 与对照组相比，0.61[0.47-0.91]ng/mL/h；P<0.001），IL-1β 浓度升高（0.32[0.05-0.56]ng/mL/h 与对照组相比，0.07[0.04-0.10]ng/mL/h；P=0.008）。肠腔中，缺血组 IL-8 增加（6.33[3.13-9.23]ng/mL/h 与对照组相比，0.89[0.21-1.86]ng/mL/h；P<0.001）。两组间 FD-4 无差异。与对照组相比，肺血管阻力和肺分流增加。再灌注期间，缺血组 PaO2/FiO2 比值降低。两组组织学均正常。支气管微透析检测到上皮衬液中细胞因子水平的改变，可用于连续监测肠道缺血再灌注后即刻局部肺细胞因子反应。
