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摘要：
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9FrCOOPDECH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 cm~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。
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Abstract: 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 endotracheal 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 T1 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=13.747,P<0.05). IL-6 and TNF-α concentrations 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.
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