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| 肢体缺血预处理对肺叶切除术患者肺的保护作用 |
| Pulmonary protective effect of extremity ischemic preconditioning in patients undergoing pulmonary lobectomy |
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| DOI：10.12089/jca.2018.03.004 |
| 中文关键词: 缺血预处理 Toll样受体4 单核细胞 肺叶切除术 |
| 英文关键词: Ischemic preconditioning Toll-like receptor 4 Monocytes Pneumonectomy |
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| 中文摘要: |
| 目的 评价肢体缺血预处理对肺叶切除术患者的肺保护作用, 并进一步探讨其可能存在的相关机制。方法 择期行胸腔镜肺叶切除术患者40例, 男26例, 女14例, 年龄45～64岁, BMI 20～28 kg/m2, ASA Ⅰ 或 Ⅱ 级。随机分为两组: 肢体缺血预处理组(P组)，左下肢根部绑止血带, 充气阻断下肢血流5 min, 再放气恢复血流5 min, 如此循环3次;对照组(C组)，左下肢绑止血带未充气30 min。所有患者均采用静-吸复合麻醉。分别于入室时、术后6、12、24 h采集静脉血样检测Toll样受体4（TLR4）的表达，并于上述各时点采集动脉血样, 计算肺泡-动脉氧分压差(PA-aO2)、呼吸指数(RI)和氧合指数(OI),记录术后48 h内肺部并发症和P组左下肢不良反应。结果 与入室时比较, 术后6、12、24 h两组TLR4表达均明显上升, 但P组明显低于C组(P＜0.05);与入室时比较, 术后6、12、24 h两组PA-aO2、RI明显升高, OI明显降低(P＜0.05);与C组比较, P组PA-aO2、RI明显降低, OI明显升高(P＜0.05)。术后两组患者肺炎和肺不张发生率差异无统计学意义, 两组均未见呼吸衰竭。P组患者左下肢无皮肤破溃、血栓栓塞、神经损伤等不良反应。结论 肢体缺血预处理对肺叶切除术患者肺具有保护作用, 与下调血液单核细胞TLR4的表达、减轻全身炎症反应有关。 |
| 英文摘要: |
| Objective To evaluate the effect of extremity ischemia preconditioning on lung protection in patients undergoing pulmonary lobectomy, and to further explore its possible mechanisms. Methods Forty patients (male 26 and female 14, BMI 20-28 kg/m2, ASA Ⅰ or Ⅱ, aged 45-64 years old)scheduled for elective pulmonary lobectomy via a thoracoscope, were randomly divided into two groups: extremity ischemic preconditioning group (group P) had the left leg roots tied with a tourniquet, lower extremity blood flow aerated blocked for 5 min, then deflated to restore blood flow for 5 min, the cycle was repeated three times; control group (group C) had the left lower extremity tied but not charged for 30 min. All the patients underwent intravenous-inhaled composite anesthesia. Arterial and venous blood samples were taken after admission to the operating room, at 6 h, 12 h and 24 h after operation. The alveolar-arterial oxygen pressure difference (PA-aO2), respiratory index(RI) and oxygenation index (OI) were calculated. The level of TLR4 was measured. The pulmonary complications within 48 h after operation were recorded. The adverse reactions of the left lower extremity of the group P were recorded. Results Compared with the admission to the operating room, the expression of TLR4 was significantly increased in the two groups at 6 h,12 h and 24 h after operation, but the expression of the group P was significantly lower than that of group C (P＜0.05). Compared with the admission to the operating room, PA-aO2 and RI were significantly increased, and OI was significantly decreased in the two groups at 6 h,12 h and 24 h after operation (P＜0.05). Compared with group C, PA-aO2and RI were significantly decreased, and OI was significantly increased in group P (P＜0.05).There was no statistically significant difference in the incidence of pneumonia and atelectasis in the two groups after operation, and no respiratory failure was observed in both groups. The left lower extremity of the group P had no adverse reactions, such as rupture of skin, thromboembolism, and nerve injury. Conclusion Extremity ischemic preconditioning has protective effect on pulmonary function in the patients undergoing pulmonary lobectomy, which may be related to down-regulation of TLR4 expression in monocytes of blood and inhibition of the systemic inflammatory response. |
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