Waller D A, Keavey P, Woodfine L, Dark J H
Regional Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom.
Ann Thorac Surg. 1996 May;61(5):1435-40. doi: 10.1016/0003-4975(96)00103-8.
Increased pulmonary endothelial permeability has been proposed as a cause of postpneumonectomy pulmonary edema. This study investigated changes in pulmonary endothelial permeability after major lung resection.
Lung scintigraphy was performed in 21 men (median age, 66 years; range, 34 to 73 years) after pneumonectomy (10 patients) or lobectomy (11 patients). Pulmonary endothelial permeability was measured by the net pulmonary accumulation of intravenous technetium-99m-labeled albumin, calculated as a ratio of lung:heart radioactivity counts. Pulmonary hemodynamics were monitored continuously by a pulmonary artery catheter, and serum levels of inflammatory cytokines were assayed.
The lung:heart radioactivity ratio increased significantly in the initial 8 hours after pneumonectomy but not after lobectomy (p < 0.01). Mean pulmonary artery pressure and pulmonary vascular resistance both increased significantly during pneumonectomy (p < 0.05). The intraoperative increase in mean pulmonary artery pressure was inversely related to preoperative mean pulmonary artery pressure (r = -0.47; p = 0.02). The postoperative change in lung:heart radioactivity ratio to the perioperative increase in pulmonary vascular resistance (r = 0.54; p = 0.02) but not to the increase in mean pulmonary artery pressure (r = 0.14; p > 0.05). Serum interleukin-8 and neutrophil elastase levels were elevated in all patients preoperatively. The postoperative change in lung:heart radioactivity ratio was related to preoperative elastase levels (r = 0.61; p = 0.02).
Pulmonary endothelial permeability appears to be increased after pneumonectomy. Preoperative neutrophil activation and the adaptation of the remaining pulmonary vasculature may be etiologic factors.
肺内皮通透性增加被认为是肺切除术后肺水肿的一个原因。本研究调查了大肺切除术后肺内皮通透性的变化。
对21名男性（年龄中位数为66岁；范围为34至73岁）进行了肺闪烁扫描，其中10例行肺切除术，11例行肺叶切除术。通过静脉注射99m锝标记白蛋白的肺净蓄积量来测量肺内皮通透性，计算为肺与心脏放射性计数之比。通过肺动脉导管持续监测肺血流动力学，并检测炎症细胞因子的血清水平。
肺切除术后最初8小时内肺与心脏放射性比值显著增加，而肺叶切除术后未增加（p < 0.01）。肺切除术中平均肺动脉压和肺血管阻力均显著增加（p < 0.05）。术中平均肺动脉压的增加与术前平均肺动脉压呈负相关（r = -0.47；p = 0.02）。术后肺与心脏放射性比值的变化与围手术期肺血管阻力的增加相关（r = 0.54；p = 0.02），但与平均肺动脉压的增加无关（r = 0.14；p > 0.05）。所有患者术前血清白细胞介素-8和中性粒细胞弹性蛋白酶水平均升高。术后肺与心脏放射性比值的变化与术前弹性蛋白酶水平相关（r = 0.61；p = 0.02）。
肺切除术后肺内皮通透性似乎增加。术前中性粒细胞激活和剩余肺血管系统的适应性可能是病因学因素。
