选择性肺叶隔离对胸科手术患者氧合及细胞因子的影响

Objective To determine the effect on concentrations of interleukin (IL-6) and tumor necrosis factor-α (TNF-α) in bronchoalveolar lavage fluid (BALF) and serum and oxygenation during selective lobar blockade. Methods Thirty patients undergoing esophagectomy or lobectomy were randomly assigned to the total lung collapse (TLC) group (n=15) and the selective lobar blockade (SLB) group( n=15). Anesthesia was induced and maintained with target-controlled infusion of propofol and remifentanil. After intubating with a 8.0 mm internal diameter single -lumen endotraeheal tube, by the guidance of fiberoptic bronchoscope, a 9F coopdech endobronchial blocker was placed into the target lobe in the SLB group, whereas the blocker was placed into the mainstem bronchus in the TLC group. Intermittent arterial blood gas analysis was performed at the following times: 15 min after two lung ventilation in the lateral decubitus position(T1)); 30 min (T2)and 60 min (T3) after TLC or SLB respectively; 15 min after recovering to two lung ventilation (T4), peak inspiratory airway pressure (Ppeak) was also recorded. BALF and blood samples were collected at T, and T4, the concentrations of IL-6 and TNF -α were measured using enzyme -linked immunosorbent assay. Results airway pressure increased significantly after the beginning of one-lung ventilation (F=215.746,P<0.05)in both groups, with more increasing extent in group T (F=53.798, P<0.01).Significant trends were found toward a better improvement in oxygention index with the group S compared with the group T after the beginning of one lung ventilation (F=1 3.747, P<0.05). IL-6 and TNF-αconcentrations of the serum and BALF collected at T4 increased significantly in both groups, but the concentrations of IL-6 and TNF-α in serum and BALF in the group S was lower than those in the TLC group (IL-6:F=1503.734,P<0.01;TNF-α:F=1423.486,P<0.05). The incidence of postoperative complications was comparable between both groups. Conclusion The SLB strategy improves oxygenation and decreases the proinflammatory cytokines during thoracic surgery.     

选择性肺叶隔离术对血清及肺泡灌洗液中IL-6和TNF-α的影响

目的 探讨选择性肺叶隔离技术对胸科手术患者血清及支气管肺泡灌洗液中 IL-6、TNF-α浓度的影响.方法 选择限期行食管癌根治术或肺癌行肺叶切除术的患者32例,随机分为选择性肺叶隔离组(S组)和全肺萎陷单肺通气组(T组)各16例.丙泊酚、瑞芬太尼靶控输注诱导及维持麻醉,插入ID 8.0 mm单腔气管导管后,将9Fr Coopdech支气管阻塞器在纤维支气管镜引导下放置,S组将套囊置入目标肺叶支气管入口下方1 cm,T组将套囊置入主支气管入口下方1.5～2 cm.于侧卧位双肺通气15 min(T1)和单肺通气结束15 min(T2)收集动脉血和支气管肺泡灌洗液,ELISA法测定IL-6、TNF-α的浓度,观察纪录术后并发症.结果 T2 与T1比较,两组患者IL-6、TNF-α的浓度均明显增加(P<0.01),S组T2时IL-6、TNF-α的浓度均低于T组(P<0.01).结论 选择性肺叶隔离技术可以减少体内促炎性因子的释放,降低术后并发症,利于术后恢复,在胸科手术中具有明显的应用优势.     

选择性肺叶隔离对胸科手术患者氧合及细胞因子的影响

Objective To determine the effect on concentrations of interleukin (IL-6) and tumor necrosis factor-α (TNF-α) in bronchoalveolar lavage fluid (BALF) and serum and oxygenation during selective lobar blockade. Methods Thirty patients undergoing esophagectomy or lobectomy were randomly assigned to the total lung collapse (TLC) group (n=15) and the selective lobar blockade (SLB) group( n=15). Anesthesia was induced and maintained with target-controlled infusion of propofol and remifentanil. After intubating with a 8.0 mm internal diameter single -lumen endotraeheal tube, by the guidance of fiberoptic bronchoscope, a 9F coopdech endobronchial blocker was placed into the target lobe in the SLB group, whereas the blocker was placed into the mainstem bronchus in the TLC group. Intermittent arterial blood gas analysis was performed at the following times: 15 min after two lung ventilation in the lateral decubitus position(T1)); 30 min (T2)and 60 min (T3) after TLC or SLB respectively; 15 min after recovering to two lung ventilation (T4), peak inspiratory airway pressure (Ppeak) was also recorded. BALF and blood samples were collected at T, and T4, the concentrations of IL-6 and TNF -α were measured using enzyme -linked immunosorbent assay. Results airway pressure increased significantly after the beginning of one-lung ventilation (F=215.746,P<0.05)in both groups, with more increasing extent in group T (F=53.798, P<0.01).Significant trends were found toward a better improvement in oxygention index with the group S compared with the group T after the beginning of one lung ventilation (F=1 3.747, P<0.05). IL-6 and TNF-αconcentrations of the serum and BALF collected at T4 increased significantly in both groups, but the concentrations of IL-6 and TNF-α in serum and BALF in the group S was lower than those in the TLC group (IL-6:F=1503.734,P<0.01;TNF-α:F=1423.486,P<0.05). The incidence of postoperative complications was comparable between both groups. Conclusion The SLB strategy improves oxygenation and decreases the proinflammatory cytokines during thoracic surgery.     

PTEN和Beclin-1在儿童非霍奇金淋巴瘤组织中的表达及其临床意义

目的:探讨PTEN、Beclin-1在儿童非霍奇金淋巴瘤（non-Hodgkin's lymphoma,NHL）组织中的表达特点及其临床意义。方法:采用免疫组织化学SP法检测儿童NHL及淋巴结反应性增生（reactive hyperplasia,RH）组织中PTEN蛋白、Beclin-1蛋白的表达,应用χ2检验比较此两种蛋白在NHL及RH组织中的阳性表达率,进一步分析此两种蛋白与患儿临床病理因素（性别、年龄、T/B分型、St.Jude分期、LDH水平、有无B症状、Ki-67及IPI危险度分层）的关系及两者的相关性。结果:儿童NHL组织中PTEN蛋白阳性率为47.2%,低于RH组织（80.8%）（χ2=7.161,P＜0.05）。PTEN蛋白的表达与NHL患儿IPI危险度分层及LDH水平相关。儿童NHL组织中Beclin-1蛋白阳性率为50.0%,低于RH组织（84.6%）（χ2=7.902,P＜0.05）。Beclin-1的表达与NHL患儿的临床病理特征无明显相关性。Spearman等级相关分析显示PTEN蛋白和Beclin-1蛋白在儿童NHL组织中的表达呈正相关（r=0.501,P＜0.05）。结论:PTEN基因和Beclin-1基因在儿童NHL中缺失或失表达,可能促进疾病发生发展。此两种抑癌基因在NHL的发生中可能起协同作用,联合检测可能有助于诊断及预后判断。     

PDE-4抑制剂对氯胺酮导致幼年大鼠学习记忆障碍的改善作用

目的探讨磷酸二酯酶-4(PDE-4)抑制剂对氯胺酮导致幼年大鼠学习记忆障碍的作用机制。方法选取SD大鼠40只,随机分为对照组,氯胺酮组,氯胺酮+PDE-4抑制剂组,氯胺酮+PDE-4抑制剂溶媒组,各组10只,其中对照组注射生理盐水,氯胺酮组注射70mg/kg氯胺酮,氯胺酮+PDE-4抑制剂组注射70mg/kg氯胺酮和0.5mg/kg Ro20-1724,氯胺酮+PDE-4抑制剂溶媒组注射70mg/kg氯胺酮和0.1%乙醇,采用Morris水迷宫方法测试大鼠行为学,Western blot检测海马CA1区EGFR、CREB和BDNF蛋白水平。结果氯胺酮+PDE-4抑制剂组第2d、第3d和第4d逃避潜伏期分别为44.72±4.10s、33.82±4.10s和24.10±3.81s,明显低于氯胺酮组和氯胺酮+PDE-5抑制剂溶媒组(P0.05),与对照组比较差异无统计学意义(P0.05);氯胺酮+PDE-4抑制剂组穿越平台次数为6.00±1.02次,明显高于氯胺酮组和氯胺酮+PDE-5抑制剂溶媒组(P0.05),与对照组比较差异无统计学意义(P0.05);氯胺酮+PDE-4抑制剂组海马CA1区EGFR、CREB和BDNF蛋白相对表达量分别为0.761±0.100、0.370±0.081和0.418±0.092,明显低于氯胺酮组和氯胺酮+PDE-5抑制剂溶媒组(P0.05),与对照组比较差异无统计学意义(P0.05)。结论 PDE-4抑制剂可改善氯胺酮导致的幼年大鼠学习记忆障碍,可能与其影响大鼠海马CA1区EGFR、CREB和BDNF蛋白表达有关。     

选择性肺叶隔离术对血清及肺泡灌洗液中IL-6、TNF-α的影响

目的 探讨选择性肺叶隔离技术对胸科手术患者血清及支气管肺泡灌洗液中 IL-6、TNF-α浓度的影响。方法 选择限期行食管癌根治术或肺癌行肺叶切除术的患者32例,随机分为选择性肺叶隔离组(S组)和全肺萎陷单肺通气组(T组)各16例。丙泊酚、瑞芬太尼靶控输注诱导及维持麻醉,插入ID8.0 mm单腔气管导管后,将9Fr COOPDECH支气管阻塞器在纤维支气管镜引导下放置,S组将套囊置入目标肺叶支气管入口下方1cm,T组将套囊置入主支气管入口下方1.5~2 cm。于侧卧位双肺通气15 min(T1)和单肺通气结束15 min(T2)收集动脉血和支气管肺泡灌洗液,ELISA法测定IL-6、TNF-α的浓度,观察纪录术后并发症。结果 T2 与T1比较,两组患者IL-6、TNF-α的浓度均明显增加(P<0.01),S组T2时IL-6、TNF-α的浓度均低于T组(P<0.01)。结论 选择性肺叶隔离技术可以减少体内促炎性因子的释放,降低术后并发症,利于术后恢复,在胸科手术中具有明显的应用优势。     

选择性肺叶隔离对胸科手术患者氧合及细胞因子的影响

目的 探讨选择性肺叶隔离技术对胸科手术患者m清及支气管肺泡灌洗液中IL-6、TNF-α浓度及氧合作用的影响.方法 选择限期行食管癌根治术或肺癌行肺叶切除术的患者30例,随机分为选择性肺叶隔离组(S组)和全肺萎陷单肺通气组(T组)各15例.丙泊酚、瑞芬太尼靶控输注诱导及维持麻醉,插入ID8.0 mm单腔气管导管后,将9Fr COOPDECH支气管阴塞器在纤维支气管镜引导下放置,S组将套囊置入目标肺叶支气管人口下方1 cm,T组将套囊置入主支气管入口下方1.5cm～2 cm.于侧卧位双肺通气15 min(T1)、单肺通气或肺叶隔离30 min(T2)、单肺通气或肺叶隔离60 min(T3)和恢复双肺通气15 min(T4)行动脉血气分析并记录气道峰压,于T1和T4时间点收集动脉血和支气管肺泡灌洗液,ELISA法测定IL-6、TNF-α的浓度.结果 单肺通气开始后两组气道压较单肺通气前明显升高(F=215.746,P<0.05),T组升高程度大于S组(F=53.798,P<0.01).单肺通气开始后两组氧合指数均下降,S组下降程度小于T组(F=13.747,P<0.05).单肺通气结束后(T4)两组血清及支气管肺泡灌洗液中IL-6、TNF-α的浓度均明显增加,S组IL-6、TNF-α的浓度均低于T组(IL-6:F=1503.734,P<0.01;TNF-α:F=1423.486,P<0.05).两组术后并发症发生率差异无统计学意义.结论 胸科手术选择性肺叶隔离通气方式能改善机体氧合,减少患者体内促炎性因子的释放.