Department of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
Anesthesiology. 2011 Jul;115(1):65-74. doi: 10.1097/ALN.0b013e318214b9de.
One-lung ventilation (OLV) results in alveolar proinflammatory effects, whereas their extent may depend on administration of anesthetic drugs. The current study evaluates the effects of different volatile anesthetics compared with an intravenous anesthetic and the relationship between pulmonary and systemic inflammation in patients undergoing open thoracic surgery.
Sixty-three patients scheduled for elective open thoracic surgery were randomized to receive anesthesia with 4 mg · kg⁻¹ · h⁻¹ propofol (n = 21), 1 minimum alveolar concentration desflurane (n = 21), or 1 minimum alveolar concentration sevoflurane (n = 21). Analgesia was provided by remifentanil (0.25 μg · kg⁻¹ · min⁻¹). After intubation, all patients received pressure-controlled mechanical ventilation with a tidal volume of approximately 7 ml · kg ideal body weight, a peak airway pressure lower than 30 cm H₂O, a respiratory rate adjusted to a Paco2 of 40 mmHg, and a fraction of inspired oxygen lower than 0.8 during OLV. Fiberoptic bronchoalveolar lavage of the ventilated lung was performed immediately after intubation and after surgery. The expression of inflammatory cytokines was determined in the lavage fluids and serum samples by multiplexed bead-based immunoassays.
Proinflammatory cytokines increased in the ventilated lung after OLV. Mediator release was more enhanced during propofol anesthesia compared with desflurane or sevoflurane administration. For tumor necrosis factor-α, the values were as follows: propofol, 5.7 (8.6); desflurane, 1.6 (0.6); and sevoflurane, 1.6 (0.7). For interleukin-8, the values were as follows: propofol, 924 (1680); desflurane, 390 (813); and sevoflurane, 412 (410). (Values are given as median [interquartile range] pg · ml⁻¹). Interleukin-1β was similarly reduced during volatile anesthesia. The postoperative serum interleukin-6 concentration was increased in all patients, whereas the systemic proinflammatory response was negligible.
OLV increases the alveolar concentrations of proinflammatory mediators in the ventilated lung. Both desflurane and sevoflurane suppress the local alveolar, but not the systemic, inflammatory responses to OLV and thoracic surgery.
单肺通气（OLV）会导致肺泡炎症反应，但其程度可能取决于麻醉药物的使用。本研究评估了不同挥发性麻醉剂与静脉麻醉相比对行开胸手术患者的影响，以及肺和全身炎症之间的关系。
63 名择期行开胸手术的患者被随机分为四组，分别接受 4mg·kg-1·h-1异丙酚（n=21）、1 最低肺泡有效浓度地氟烷（n=21）或 1 最低肺泡有效浓度七氟烷（n=21）麻醉。镇痛采用瑞芬太尼（0.25μg·kg-1·min-1）。插管后，所有患者均接受压力控制机械通气，潮气量约为 7ml·kg 理想体重，气道峰压低于 30cmH2O，呼吸频率调整至 Paco2 为 40mmHg，吸入氧分数低于 0.8，进行 OLV。OLV 后立即对通气肺进行纤维支气管肺泡灌洗。通过多重珠基免疫测定法在灌洗液和血清样本中测定炎症细胞因子的表达。
OLV 后通气肺中的促炎细胞因子增加。与地氟烷或七氟烷相比，丙泊酚麻醉时介质释放增强。对于肿瘤坏死因子-α，数值如下：丙泊酚，5.7（8.6）；地氟烷，1.6（0.6）；七氟烷，1.6（0.7）。对于白细胞介素-8，数值如下：丙泊酚，924（1680）；地氟烷，390（813）；七氟烷，412（410）。（数值以中位数[四分位距]pg·ml-1表示）。挥发性麻醉时白细胞介素-1β也相似减少。所有患者术后血清白细胞介素-6 浓度均升高，而全身促炎反应可忽略不计。
OLV 增加通气肺中促炎介质的肺泡浓度。地氟烷和七氟烷均能抑制 OLV 和开胸手术引起的局部肺泡炎症反应，但不抑制全身炎症反应。
