国际麻醉学与复苏杂志   2012, Issue (9): 4-4
    
不同时间单肺通气对兔肺泡灌洗液中肿瘤坏死因子α、白介素-8和肺组织表面活性蛋白A的影响
蓝岚, 古妙宁, 叶靖, 李舒珏, 吴文起, 岑燕遗1()
1.广州医学院第一附属医院
The effect of different one-lung ventilation time on rabbit tumor necrosis factor-α and interleukin-8 in alveolar lavage fluid and surfactant protein A in lung tissue
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摘要:

目的 观察不同时间单肺通气(one lung ventilation, OLV)对兔支气管肺泡灌洗液中肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α) 和白介素-8(interleukin-8, IL-8),以及肺组织表面活性蛋白A(surfactant protein A , SP-A)的影响。方法 选择新西兰大白兔60只。按完全随机分组方法随机均分为C组和O1、O2、O3、O4、O5组(每组10只)。O1~O 5组建立右肺单肺通气,分别给予单肺通气1、2、3、4、5 h。各组中5只兔子完成单肺通气后立即处死,另5只兔子拔除各种管道自然养活24 h,分别测定左右肺灌洗液中细胞数、TNF-α、IL-8浓度和肺组织SP-A。结果OLV时,与C组比较,O3~O5组左右肺细胞数均大于4.64±0.79(P<0.01);O4和O5组二氧化碳分压(PaCO2)高于43.6±5.7 (P<0.01);O3~O5组左肺TNF-α均升高大于101.90±18.65(P<0.01),O4~O5组左肺IL-8升高大于256.16±30.32(P<0.01),O5组右肺TNF-α、IL-8升高(P<0.01)。24 h后,O4~O5组左肺细胞数仍高于7.5±1.9(P<0.01);左肺IL-8值在O5组为214.60±76.74(P<0.01)。左肺与右肺间的TNF-α和IL-8值在OLV时与24 h后各时点比较均无统计学差异(P>0.05)。与C组比较,O1~O3组左肺SP-A灰度值均大于13.84±3.47(P<0.01)、O1~O5组右肺SP-A均大于5.51±1.48(P<0.01),O4~O5组SP-A表达减少;24 h后O1~O5组左右肺SP-A表达均大于12.17±4.75(P<0.01)。结论 随着OLV时间延长,肺炎症反应明显及肺SP-A表达减少;在OLV超过3 h,即使恢复双肺通气24 h后,肺损伤仍难以完全修复,应避免OLV时间过长。

关键词: 单肺通气;炎症因子;支气管肺泡灌洗;表面活性蛋白-A
Abstract:

Objective To investigate the effect of different one-lung ventilation (OLV) time on TNF-α and IL-8 in rabbit bronchoalveolar lavage fluid, and the surfactant protein- A(SP-A) in lung tissue. Methods 60 male rabbits were randomly divided into group C, group O1, O2, O3, O4 and O5. Group O1-O5 were established the right lung ventilation and given 1, 2, 3, 4 and 5 hours ventilation. Five rabbits in each group were made execution after completing ventilation, the other five rabbits were executed after feeding 24 h. TNF-α, IL-8 concentrations and SA of all rabbits were measured. Results When compared with group C during OLV, cell number in left and right lung of group O3-O5 increased over 4.64±0.79(P<0.01), PaCO2 in group O4-O5 increased over 43.6±5.7 (P <0.01); TNF-α and IL-8 in left lung of group O3-O5 increased over 101.90±18.65(P<0.01), and TNF-α and IL-8 in right lung of group O4-O5 increased 256.16±30.32(P<0.01). 24 hours later, cell number in left lung was still higher than 7.5±1.9 (P <0.01); IL-8 in left lung of group O5 was still higher than 214.60±76.74(P<0.01). TNF-α and IL-8 in left and right lung had no difference during OLV and 24 h later(P>0.05).When compared with group C, SP-A in left lung of group O1-O3 increased over than 13.84±3.47(P<0.01), and SP-A in right lung of group O1-O5 increased over than 5.51±1.48(P<0.01), but SP-A decreased expression in group O4-O5. SP-A in left and right lung of group O1-O5 increased expression more than 12.17±4.75 in 24 h later (P <0.01). Conclusions Lung inflammatory response increases and SP-A decreases with prolonged OLV; especially when OLV is longer than 3 h, lung injury is difficult to repair even after 24 h. It should be avoided to have long time one-lung ventilation.

Key words: One-lung ventilation; Inflammatory cytokines; Bronchoalveolar lavage;Surfactant protein -A