Lantos Judit, Németh Tibor, Barta Zsanett, Szabó Zsolt, Paróczai Dóra, Varga Endre, Hartmann Petra
Department of Neurology, Bács-Kiskun County Hospital, Kecskemet, Hungary.
Department of Surgery, University of Szeged, Szeged, Hungary.
Front Surg. 2022 Mar 14;9:822560. doi: 10.3389/fsurg.2022.822560. eCollection 2022.
Surgical procedures cause stress, which can induce an inflammatory response and reduce immune function. Following video-assisted thoracoscopic surgery (VATS), non-intubated thoracic surgery (NITS) was developed to further reduce surgical stress in thoracic surgical procedures. This article reviews the pathophysiology of the NITS procedure and its potential for reducing the negative effects of mechanical one-lung ventilation (mOLV). In NITS with spontaneous ventilation, the negative side effects of mOLV are prevented or reduced, including volutrauma, biotrauma, systemic inflammatory immune responses, and compensatory anti-inflammatory immune responses. The pro-inflammatory and anti-inflammatory cytokines released from accumulated macrophages and neutrophils result in injury to the alveoli during mOLV. The inflammatory response is lower in NITS than in relaxed-surgery cases, causing a less-negative effect on immune function. The increase in leukocyte number and decrease in lymphocyte number are more moderate in NITS than in relaxed-surgery cases. The ventilation/perfusion match is better in spontaneous one-lung ventilation than in mOLV, resulting in better oxygenation and cardiac output. The direct effect of relaxant drugs on the acetylcholine receptors of macrophages can cause cytokine release, which is lower in NITS. The locoregional anesthesia in NITS is associated with a reduced cytokine release, contributing to a more physiological postoperative immune function.
外科手术会引发应激反应，这可能会诱发炎症反应并降低免疫功能。继电视辅助胸腔镜手术（VATS）之后，非插管胸外科手术（NITS）应运而生，旨在进一步减轻胸外科手术中的应激反应。本文综述了NITS手术的病理生理学及其减轻机械性单肺通气（mOLV）负面影响的潜力。在自主通气的NITS中，mOLV的负面效应可得到预防或减轻，包括容积伤、生物伤、全身炎症免疫反应和代偿性抗炎免疫反应。mOLV期间，积聚的巨噬细胞和中性粒细胞释放的促炎和抗炎细胞因子会导致肺泡损伤。NITS中的炎症反应低于宽松手术病例，对免疫功能的负面影响较小。与宽松手术病例相比，NITS中白细胞数量的增加和淋巴细胞数量的减少更为适度。自主单肺通气时的通气/灌注匹配优于mOLV，从而实现更好的氧合和心输出量。松弛药物对巨噬细胞乙酰胆碱受体的直接作用可导致细胞因子释放，而在NITS中这种释放较低。NITS中的局部区域麻醉与细胞因子释放减少有关，有助于术后免疫功能更接近生理状态。
