支气管堵塞器对单肺通气肺损伤的保护作用与机制

发布时间：2018-12-27 10:06

【摘要】：目的单肺通气期间的机械通气可损伤肺毛细血管内皮细胞,增加毛细血管通透性,渗透并激活炎性细胞,诱发炎性反应,从而进一步加重肺组织的损伤。本研究拟通过对照观察支气管堵塞器与双腔支气管导管对单肺通气患者氧合和肺毛细血管内皮细胞的影响,旨在探讨支气管堵塞器对单肺通气肺损伤的保护作用及其可能的机制方法择期行食管癌根治术患者40例,ASA (American Society of Anesthesiologists ASA)Ⅰ～Ⅱ级,随机均分为2组：支气管堵塞器组(Bronchial blocker tube BBT组)和双腔支气管组(Double-lumen bronchial tube DLT组),各20例。两组采用相同的麻醉诱导方式,诱导成功后,DLT组插入35号或37号双腔支气管导管；BBT组插入7.0-7.5ID单腔气管导管,在纤维支气管镜(OLYPUSLF GP,4.0mm日本)引导下,插入一次性支气管堵塞器于开胸侧的支气管内,两组均以全凭静脉维持麻醉。评估记录以下数据：(1)两组患者插管前后血流动力学变化；(2)分别抽取两组患者于麻醉诱导前(T1)、切皮即刻(T2)、单肺通气60分钟(T3)、手术结束即刻(T4)四个时间点的动脉血,进行血气分析,评价两种方法的氧合情况；(3)两组患者单肺通气时的气道峰压(peak airway pressures);(4)用酶联免疫吸附法(ELISA)测定切皮即刻(T2)、单肺通气60分钟(T3)、术毕2h(T5)三个时间点血浆血管性假血友病因子(von Willebrand factorvWF)和可溶性细胞间粘附分子(soluble Intercellular adhesion molecule-1sICAM-1)的血浆浓度,评价两种单肺通气方法对全身炎性反应的影响;(5)观察手术开始与手术结束时切取的肺组织的病理改变。结果与DLT组相比,BBT组插管前后平均动脉压(mean arterial pressure MAP)和心率(heart rate HR)变化率小(P0.05)；与T2时相比较,两组患者于T3时Pa02下降、P peak升高,以DLT组变化明显(P0.05)；两组血浆vWF水平在T3、T4、T5时升高,sICAM-1水平于T5时升高(P0.05),T5时BBT组vWF和sICAM-1水平低于DLT组(P0.05)；手术开始与手术结束,两组患者肺组织HE染色病理形态学比较有变化,以DLT组变化明显。结论支气管堵塞器对单肺通气肺损伤的保护作用,其机制可能是通过减低单肺通气时的气道压力,减轻了单肺通气的肺损伤；改善肺内氧合,降低了血浆中的vWF、sICAM-1水平,减轻了因单肺通气触发的全身炎性反应。
[Abstract]:Objective Mechanical ventilation during single lung ventilation can damage pulmonary capillary endothelial cells, increase capillary permeability, infiltrate and activate inflammatory cells, induce inflammatory reaction, and further aggravate lung injury. The purpose of this study was to observe the effects of bronchial occluder and double lumen bronchial catheter on oxygenation and pulmonary capillary endothelial cells in patients with single lung ventilation. To investigate the protective effect of bronchial occluder on lung injury induced by single lung ventilation and its possible mechanism 40 patients with esophageal carcinoma undergoing radical resection of esophageal carcinoma were enrolled in this study. They were randomly divided into two groups: bronchial occluder group (Bronchial blocker tube BBT group) and double lumen bronchus group (Double-lumen bronchial tube DLT group) with 20 cases each. The two groups adopted the same anesthetic induction method. After the induction was successful, the DLT group inserted 35 or 37 double lumen bronchial catheter. In BBT group, 7.0-7.5ID single lumen tracheal catheter was inserted. Under the guidance of OLYPUSLF GP,4.0mm Japan, a disposable bronchial occluder was inserted into the open side of the bronchus. Both groups were treated with total intravenous anesthesia. The following data were recorded: (1) hemodynamic changes before and after intubation in two groups; (2) the arterial blood samples of the two groups were collected before anesthesia induction (T1), immediately after skin incision (T2), 60 minutes after one-lung ventilation (T3), and at the end of operation (T4) for blood gas analysis. To evaluate the oxygenation of the two methods; (3) Airway peak pressure (peak airway pressures);) during one-lung ventilation in two groups (4) (ELISA) was used to determine immediate (T2) skin incision and 60 minutes of one-lung ventilation (T3). Plasma concentrations of plasma von Willebrand factor (von Willebrand factorvWF) and soluble intercellular adhesion molecule (soluble Intercellular adhesion molecule-1sICAM-1) were measured at 2 h after operation (T5) to evaluate the effects of two single lung ventilation methods on systemic inflammatory response. (5) the pathological changes of lung tissue were observed at the beginning and end of operation. Results the mean arterial pressure (mean arterial pressure MAP) and heart rate (heart rate HR) in BBT group were lower than those in DLT group before and after intubation (P0.05). Compared with T2, Pa02 decreased and, P peak increased at T3 in both groups, especially in DLT group (P0.05). Plasma vWF level increased at T3T4T5, sICAM-1 level increased at T5 time (P0.05), vWF and sICAM-1 levels in T5 BBT group were lower than those in DLT group (P0.05). Compared with the end of operation, the pathological changes of HE staining in lung tissue of the two groups were obvious, especially in the DLT group. Conclusion the protective effect of bronchial occluder on lung injury induced by single lung ventilation may be due to the reduction of airway pressure during single lung ventilation. Lung oxygenation was improved, vWF,sICAM-1 levels in plasma were decreased and systemic inflammatory response triggered by single lung ventilation was alleviated.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

【相似文献】