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.

Effect of cytokines and oxygenation during selective lobar blockade in thoracic surgery