Gao Yongtao, Wang Zhi, Jiang Feng, Gao Jie, Li Yujia, Liu Siyuan
Affiliated Hospital of Nantong University, No. 20 Xishi Road, 226001, Nantong City, Jiangsu Province, People's Republic of China.
Medical College of Nantong University, Nantong, People's Republic of China.
BMC Anesthesiol. 2018 Dec 11;18(1):186. doi: 10.1186/s12871-018-0652-z.
The aim of this study was to determine whether a AOI strategy on non-ventilated lung could reduce the regional and systemic proinflammatory cytokine and oxidative stress response associated with esophagectomy, and to evaluate whether AOI can be used as a novel lung protective ventilation strategy. Its impact on oxygenation after OLV, surfactant protein A, B, C (SP-A, B, C), postoperative hospital stay and postoperative pulmonary complications (PPCs) was also evaluated.
Fifty-four adults (ASA II-III) undergoing esophagectomy with OLV were enrolled in the study. Patients were randomly assigned into 2 groups: control group (group C) and treated group (group T). Group C was treated with traditional OLV mode,while group T was given AOI of 5 L/min oxygen on the non-ventilated lung immediately at the beginning of OLV. Arterial blood gas was analyzed before and after OLV. A bronchoalveolar lavage(BAL) was performed after OLV on the non-ventilated lung. Proinflammatory cytokine, oxidative stress markers(TNF-α, NF-κB,sICAM-1,IL-6,IL-10,SOD,MDA) and SP-A, B, C were analyzed in serum and BALF as the primary endpoint.The clinical outcome determined by PPCs was assessed as the secondary endpoint.
Patients with AOI had better oxygenation in the recovery period, oxygenation index(OI) (394[367-426] and 478[440-497]mmHg, respectively) of group T at T and T were significantly higher than those (332[206-434] and 437[331-512]mmHg, respectively) of group C. OLV resulted in an increase in the measured inflammatory markers in both groups, however, the increase of inflammatory markers upon OLV in the group C was significantly higher than those of group T. OLV resulted in an increase in the measured SP-A, B, C in serum of both groups. However, the levels of SP-A, B, C of group T were lower than those of group C in serum after OLV, and the results in BALF were the opposite. The BALF levels of SOD(23.88[14.70-33.93]U/ml) of group T were higher than those(15.99[10.33-24.16] U/ml) of group C, while the levels of MDA in both serum and BALF of group T(8.60[4.14-9.85] and 1.88[1.33-3.08]nmol/ml, respectively) were all lower than those of group C (11.10[6.57-13.75] and 1.280[1.01-1.83]nmol/ml) after OLV. There was no statistical difference between the two groups in terms of postoperative hospital stay and the incidence of PPCs.
AOI on non-ventilated lung during OLV can improve the oxygenation function after OLV, relieve the inflammatory and oxidative stress response in the systemic and non-ventilated lung after OLV associated with esophagectomy.
ChiCTR-IOR-17011037 . Registered on 31 March 2017.
本研究旨在确定非通气肺的肺泡内间歇正压通气（AOI）策略是否能降低与食管癌切除术相关的局部和全身促炎细胞因子及氧化应激反应，并评估AOI是否可作为一种新型的肺保护性通气策略。还评估了其对单肺通气（OLV）后氧合、表面活性蛋白A、B、C（SP-A、B、C）、术后住院时间及术后肺部并发症（PPCs）的影响。
54例接受OLV食管癌切除术的成年患者（美国麻醉医师协会分级II-III级）纳入本研究。患者随机分为2组：对照组（C组）和治疗组（T组）。C组采用传统OLV模式治疗，而T组在OLV开始时立即对非通气肺给予5L/min的AOI。OLV前后分析动脉血气。OLV后对非通气肺进行支气管肺泡灌洗（BAL）。分析血清和支气管肺泡灌洗液中的促炎细胞因子、氧化应激标志物（肿瘤坏死因子-α、核因子-κB、可溶性细胞间黏附分子-1、白细胞介素-6、白细胞介素-10、超氧化物歧化酶、丙二醛）以及SP-A、B、C作为主要终点。以PPCs确定的临床结局作为次要终点进行评估。
采用AOI的患者恢复期氧合更好，T组在T1和T2时的氧合指数（OI）（分别为394[367-426]和478[440-497]mmHg）显著高于C组（分别为332[206-434]和437[331-512]mmHg）。OLV导致两组中所测炎症标志物增加，然而，C组OLV后炎症标志物的增加显著高于T组。OLV导致两组血清中所测SP-A、B、C增加。然而，OLV后T组血清中SP-A、B、C水平低于C组，而支气管肺泡灌洗液中的结果则相反。T组支气管肺泡灌洗液中超氧化物歧化酶水平（23.88[14.70-33.93]U/ml）高于C组（15.99[10.33-24.16]U/ml），而OLV后T组血清和支气管肺泡灌洗液中的丙二醛水平（分别为8.60[4.14-9.85]和1.88[1.33-3.08]nmol/ml）均低于C组（11.10[6.57-13.75]和1.280[1.01-1.83]nmol/ml）。两组术后住院时间和PPCs发生率无统计学差异。
OLV期间对非通气肺进行AOI可改善OLV后的氧合功能，减轻与食管癌切除术相关的OLV后全身及非通气肺的炎症和氧化应激反应。
中国临床试验注册中心注册号：ChiCTR-IOR-17011037。于2017年3月31日注册。
