Bergmann Astrid, Schilling Thomas, Hedenstierna Göran, Ahlgren Kerstin, Larsson Anders, Kretzschmar Moritz, Kozian Alf, Hachenberg Thomas
Department of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Germany; Department of Medical Sciences, Hedenstierna Laboratory, Uppsala University, Sweden.
Department of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Germany.
Respir Physiol Neurobiol. 2019 Jan;259:111-118. doi: 10.1016/j.resp.2018.08.009. Epub 2018 Aug 31.
One-lung ventilation (OLV) may result in lung injury due to increased mechanical stress and tidal recruitment. As a result, a pulmonary inflammatory response is induced. The present randomized, controlled, animal experiment was undertaken to assess the effects of remote ischemic preconditioning (RIP) on diffuse alveolar damage and immune response after OLV.
Fourteen piglets (26 ± 2 kg) were randomized to control (n = 7) and RIP group (n = 7). For RIP, a blood pressure cuff at hind limb was inflated up to 200 mmHg for 5 min and deflated for another 5 min, this being done four times before OLV. Mechanical ventilation settings were constant throughout the experiment: V = 10 ml/kg, FO = 0.40, PEEP = 5cmHO. OLV was performed by left-sided bronchial blockade. Number of cells was counted from BAL fluid; cytokines were assessed by immunoassays in lung tissue and serum samples. Lung tissue samples were obtained for histological analysis and assessment of diffuse alveolar damage (DAD) score.
Hemodynamic and respiratory data were similar in both groups. Likewise, no differences in pulmonary tissue TNF-α and protein content were found, but fewer leukocytes were counted in the ventilated lung after RIP. DAD scores were high without any differences between controls and RIP. On the other hand, alveolar edema and microhemorrhage were significantly increased after RIP.
OLV results in alveolar injury, possibly enhanced by RIP. On the other hand, RIP attenuates the immunological response and decreased alveolar leukocyte recruitment in a porcine model of OLV.
单肺通气（OLV）可能因机械应力增加和潮气量募集而导致肺损伤。因此，会引发肺部炎症反应。本随机对照动物实验旨在评估远程缺血预处理（RIP）对OLV后弥漫性肺泡损伤和免疫反应的影响。
14只仔猪（26±2 kg）随机分为对照组（n = 7）和RIP组（n = 7）。对于RIP，在后肢使用血压袖带充气至200 mmHg持续5分钟，然后放气5分钟，在OLV前重复4次。整个实验过程中机械通气设置保持不变：V = 10 ml/kg，FO = 0.40，PEEP = 5 cmH₂O。通过左侧支气管封堵进行OLV。从支气管肺泡灌洗（BAL）液中计数细胞数量；通过免疫测定法评估肺组织和血清样本中的细胞因子。获取肺组织样本进行组织学分析和评估弥漫性肺泡损伤（DAD）评分。
两组的血流动力学和呼吸数据相似。同样，在肺组织TNF-α和蛋白质含量方面未发现差异，但RIP后通气肺中的白细胞计数较少。DAD评分较高，对照组和RIP组之间无差异。另一方面，RIP后肺泡水肿和微出血明显增加。
OLV导致肺泡损伤，RIP可能会加重这种损伤。另一方面，在猪OLV模型中，RIP可减轻免疫反应并减少肺泡白细胞募集。
