Unit of Critical Care, National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, UK.
Respirology. 2011 Jan;16(1):138-45. doi: 10.1111/j.1440-1843.2010.01870.x.
Acute lung injury contributes to the mortality of patients after lung resection and one-lung ventilation (OLV). The objective of this study was to characterise the effect of lung resection and OLV on proposed biomarkers of lung injury in exhaled breath condensate (EBC) and plasma.
In adults undergoing lung resection, EBC was collected before and at 30-min intervals during OLV. Inflammatory mediators were assayed in plasma samples taken preoperatively, immediately postoperatively and 24 h postoperatively.
EBC pH decreased from 6.51 ± 0.43 preoperatively, to 6.17 ± 0.78 and 6.09 ± 0.83 at 30 and 60 min, respectively (mean ± SD, P = 0.034, n = 20). Plasma concentrations of the receptor for advanced glycation end-products, von Willebrand factor and interleukin-6 increased comparing preoperative and postoperative samples (all P < 0.001, n = 30). By contrast, levels of Krebs von den Lungen-6 and surfactant protein-D decreased (P < 0.001, n=30), and correlated inversely with the extent of lung resected.
Lung resection and OLV was associated with a rapid reduction in EBC pH and differential changes in plasma biomarkers of lung injury. Further investigation of EBC pH as a marker of ventilator-induced lung injury is warranted.
急性肺损伤是导致肺切除和单肺通气（OLV）术后患者死亡的原因之一。本研究旨在探讨肺切除和 OLV 对呼气冷凝液（EBC）和血浆中肺损伤生物标志物的影响。
选择行肺切除术的成年人，在 OLV 前和 OLV 期间每隔 30 分钟采集 EBC。术前、术后即刻和术后 24 小时采集血浆样本，检测炎性介质。
EBC pH 值从术前的 6.51±0.43 降至 30 分钟时的 6.17±0.78 和 60 分钟时的 6.09±0.83（均数±标准差，P=0.034，n=20）。与术前样本相比，血浆中晚期糖基化终产物受体、血管性血友病因子和白细胞介素 6 的浓度增加（均 P<0.001，n=30）。相比之下，Krebs von den Lungen-6 和表面活性蛋白-D 的水平降低（均 P<0.001，n=30），且与切除的肺组织量呈负相关。
肺切除和 OLV 可导致 EBC pH 值迅速降低，并导致血浆中肺损伤生物标志物发生差异变化。进一步研究 EBC pH 值作为呼吸机诱导性肺损伤的标志物是有必要的。
