Department of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Germany.
Minerva Anestesiol. 2013 Jun;79(6):590-603. Epub 2013 Feb 28.
Acute lung injury after thoracic surgery relates to alveolar inflammation induced by one-lung ventilation (OLV) and surgical manipulation. However, alveolar recruitment manoeuvres (ARM), conventional ventilation, and airway manipulation may increase alveolar trauma. This study evaluates pulmonary immune effects of these co-factors in a porcine model.
Twenty-two piglets (27.3 kg) were randomised to spontaneous breathing (N.=4), two-lung ventilation (TLV, N.=6), OLV with propofol (6 mg/kg/h, N.=6) or desflurane anesthesia (1MAC, N.=6). Mechanical ventilation settings were constant throughout the experiment: VT=10 mL/kg, FIO2=0.4, PEEP=5 cmH2O. OLV was performed by left-sided bronchial blockade. Thoracic surgery was simulated for 60 min. ARM (airway pressure of 40 mbar for 10 s) was applied before and after each airway manipulation. Cytokines and mRNA-expression were assessed by immunoassays and semi-quantitative RT-PCR in alveolar lavage fluids, serum and tissue samples prior to and after OLV (TLV in controls).
Repetitive ARM and TLV induced no significant proinflammatory effects. OLV enhanced cytokine release but less with desflurane inhalation than propofol infusion (median (IQR) [pg/mL], dependent lung): Interleukin-8: TLV 44 (17) to 68 (35), propofol 82 (17) to 494 (231), desflurane 89 (30) to 282 (44). Likewise, serum cytokines were different: tumour necrosis factor-a: TLV 37 (13) to 62 (7), propofol 55 (39) to 94 (60), desflurane 43 (33) to 41 (25). Expression of interleukin-8-mRNA increased after OLV, but mRNA expression was not modulated by anesthetics.
ARM, standard TLV and repetitive BAL do not additionally contribute to lung injury resulting from OLV for thoracic surgery in healthy porcine lungs. OLV induces expression of interleukin-8-mRNA in alveolar cells, which is not modulated by different anesthetic drugs.
开胸手术后的急性肺损伤与单肺通气（OLV）和手术操作引起的肺泡炎症有关。然而，肺泡复张手法（ARM）、常规通气和气道操作可能会增加肺泡创伤。本研究在猪模型中评估了这些因素的肺免疫效应。
22 头小猪（27.3kg）被随机分为自主呼吸组（N=4）、双肺通气组（TLV，N=6）、丙泊酚（6mg/kg/h，N=6）或七氟醚麻醉（1MAC，N=6）OLV 组。整个实验过程中，机械通气设置保持不变：VT=10mL/kg，FIO2=0.4，PEEP=5cmH2O。OLV 通过左侧支气管阻塞实现。模拟开胸手术 60min。在每次气道操作前后应用 ARM（气道压力 40mbar 持续 10s）。在 OLV 前（TLV 为对照组）和之后，通过免疫测定和半定量 RT-PCR 评估肺泡灌洗液、血清和组织样本中的细胞因子和 mRNA 表达。
重复 ARM 和 TLV 未引起明显的促炎作用。OLV 增强了细胞因子的释放，但七氟醚吸入比丙泊酚输注时的释放更少（依赖肺）：白细胞介素-8：TLV 44（17）至 68（35），丙泊酚 82（17）至 494（231），七氟醚 89（30）至 282（44）。同样，血清细胞因子也不同：肿瘤坏死因子-α：TLV 37（13）至 62（7），丙泊酚 55（39）至 94（60），七氟醚 43（33）至 41（25）。OLV 后白细胞介素-8-mRNA 的表达增加，但不同的麻醉药物不调节 mRNA 表达。
在健康猪肺中，对于开胸手术的 OLV，ARM、标准 TLV 和重复 BAL 不会加重 OLV 引起的肺损伤。OLV 诱导肺泡细胞中白细胞介素-8-mRNA 的表达，但不同的麻醉药物不调节其表达。
