Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, Guangdong, China.
Eur J Cardiothorac Surg. 2017 Dec 1;52(6):1083-1089. doi: 10.1093/ejcts/ezx187.
One-lung ventilation (OLV) with general anaesthesia may increase adverse effects after thoracic surgery, specifically ventilator-induced lung injury. Spontaneous ventilation (SV) has no mechanical ventilation process, thus, we established a rabbit model to assess non-operative lung injury between OLV and SV.
Thirty-six rabbits were randomly divided into 6 groups: OLV and SV (0, 2 and 4 h). Blood gas analysis was performed after thoracic surgery. Lung tissue and bronchoalveolar lavage fluid were obtained from the non-operative lung. Pathological injury score in lung tissue and tumour necrosis factor α (TNF-α) level in bronchoalveolar lavage fluid using enzyme-linked immunosorbent assay were determined. Moreover, messenger RNA and protein of TNF-α in lung tissue were also determined by quantitative reverse transcriptase polymerase chain reaction and immunohistochemistry.
Compared with the OLV group, significantly higher partial pressure of carbon dioxide (47.78 ± 3.57 vs 38.95 ± 3.88 mmHg, P < 0.01) and partial pressure of oxygen (101.08 ± 13.1 vs 85.6 ± 11.07 mmHg, P < 0.01), as well as a significantly lower pathological injury score (6.83 ± 1.17 vs 8.83 ± 1.72, P < 0.05), TNF-α level in bronchoalveolar lavage fluid (290.32 ± 29.38 vs 368.43 ± 31.26 pg/ml, P < 0.01), TNF-α messenger RNA (6.31 ± 1.13 vs 8.6 ± 1.34, P < 0.01), immunostaining intensity in lung tissue were found at 4 h in the SV group. However, there are no significant differences between OLV and SV groups at 2 h (P > 0.05), except in TNF-α messenger RNA.
Based on this rabbit model, SV for thoracic surgery is not inferior to OLV in terms of lung injury. Considering our results, when performing time-consuming thoracic procedures under OLV, surgeons should more closely examine patients for non-operative lung injury postoperatively.
全身麻醉下的单肺通气（OLV）可能会增加开胸手术后的不良影响，特别是呼吸机相关性肺损伤。自主通气（SV）没有机械通气过程，因此，我们建立了一个兔模型来评估 OLV 和 SV 之间非手术肺损伤。
36 只兔子随机分为 6 组：OLV 和 SV（0、2 和 4 h）。开胸手术后进行血气分析。从非手术肺中获取肺组织和支气管肺泡灌洗液。通过酶联免疫吸附试验测定肺组织中的病理损伤评分和支气管肺泡灌洗液中的肿瘤坏死因子 α（TNF-α）水平。此外，通过定量逆转录聚合酶链反应和免疫组化测定肺组织中 TNF-α的信使 RNA 和蛋白。
与 OLV 组相比，SV 组的二氧化碳分压（47.78±3.57 比 38.95±3.88mmHg，P<0.01）和氧分压（101.08±13.1 比 85.6±11.07mmHg，P<0.01）显著升高，病理损伤评分（6.83±1.17 比 8.83±1.72，P<0.05）和支气管肺泡灌洗液中 TNF-α水平（290.32±29.38 比 368.43±31.26pg/ml，P<0.01）、肺组织中 TNF-α信使 RNA（6.31±1.13 比 8.6±1.34，P<0.01）均显著降低。然而，在 SV 组，4 h 时 SV 组的 TNF-α免疫染色强度显著低于 OLV 组（P<0.01）。但在 2 h 时，OLV 和 SV 组之间没有显著差异（P>0.05），除了 TNF-α信使 RNA。
基于该兔模型，SV 用于开胸手术在肺损伤方面并不劣于 OLV。考虑到我们的结果，在进行耗时的 OLV 开胸手术时，外科医生应该更密切地检查术后非手术肺损伤的患者。
