Gao Wei, Liu Dong-Dong, Li Di, Cui Guang-xiao
From the Department of Anesthesiology, the Second Affiliated Hospital of the Harbin Medical University, Harbin, Heilongjiang Province, China.
Anesthesiology. 2015 Jun;122(6):1235-52. doi: 10.1097/ALN.0000000000000627.
One-lung ventilation (OLV) can result in local and systemic inflammation. This prospective, randomized trial was to evaluate the effect of therapeutic hypercapnia on lung injury after OLV.
Fifty patients aged 20 to 60 yr undergoing lobectomy were randomly provided with air or carbon dioxide (partial pressure of carbon dioxide: 35 to 45 mmHg or 60 to 70 mmHg). Peak pressure, plateau pressure, and lung compliance were recorded. Bronchoalveolar lavage fluid (BALF) and blood samples were collected. Adverse events were monitored. The primary outcome was the concentration of BALF tumor necrosis factor, and the secondary outcomes were serum cytokine concentrations.
The BALF tumor necrosis factor was lower in the carbon dioxide group than in the air group (median [range], 51.1 [42.8 to 76.6] vs. 71.2 [44.8 to 92.7]; P = 0.034). Patients in the carbon dioxide group had lower concentrations of serum and BALF interleukin (IL)-1, IL-6, and IL-8, but higher serum concentrations of IL-10, accompanied by reduced numbers of cells and neutrophils as well as lower concentrations of protein in the BALF. Also, patients in the carbon dioxide group had lower peak (mean ± SD, 22.2 ± 2.9 vs. 29.8 ± 4.6) and plateau pressures (20.5 ± 2.4 vs. 27.1 ± 2.9), but higher dynamic compliance (46.6 ± 5.8 vs. 38.9 ± 6.5). Furthermore, patients in the carbon dioxide group had higher postoperation oxygenation index values. Ten patients experienced slightly increased blood pressure and heart rate during OLV in the carbon dioxide group.
Under intravenous anesthesia, therapeutic hypercapnia inhibits local and systematic inflammation and improves respiratory function after OLV in lobectomy patients without severe complications.
单肺通气（OLV）可导致局部和全身炎症反应。本前瞻性随机试验旨在评估治疗性高碳酸血症对OLV后肺损伤的影响。
50例年龄在20至60岁接受肺叶切除术的患者被随机给予空气或二氧化碳（二氧化碳分压：35至45 mmHg或60至70 mmHg）。记录峰值压力、平台压力和肺顺应性。收集支气管肺泡灌洗液（BALF）和血液样本。监测不良事件。主要结局指标为BALF肿瘤坏死因子浓度，次要结局指标为血清细胞因子浓度。
二氧化碳组的BALF肿瘤坏死因子低于空气组（中位数[范围]，51.1[42.8至76.6]对71.2[44.8至92.7]；P = 0.034）。二氧化碳组患者血清和BALF白细胞介素（IL）-1、IL-6和IL-8浓度较低，但血清IL-10浓度较高，同时BALF中的细胞和中性粒细胞数量减少以及蛋白质浓度降低。此外，二氧化碳组患者的峰值（平均值±标准差，22.2±2.9对29.8±4.6）和平台压力较低（20.5±2.4对27.1±2.9），但动态顺应性较高（46.6±5.8对38.9±6.5）。此外，二氧化碳组患者术后氧合指数值较高。二氧化碳组有10例患者在OLV期间血压和心率略有升高。
在静脉麻醉下，治疗性高碳酸血症可抑制肺叶切除患者OLV后的局部和全身炎症反应，并改善呼吸功能，且无严重并发症。
