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| 肺保护性通气策略对胸腔镜下肺癌根治术患者免疫功能的影响 |
| Perioperative use of lung protective ventilation strategy on immune function in patients undergoing thoracoscopic radical resection of lung cancer |
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| DOI：10.12089/jca.2019.01.002 |
| 中文关键词: 肺保护性通气 机械通气介导肺损伤 免疫功能 肺癌 |
| 英文关键词: Lung protective ventilation strategy Ventilator-induced lung injury Immune function Lung cancer |
| 基金项目:国家自然科学基金青年项目(81503080);安徽省自然科学基金青年项目(1608085QH210);吴阶平医学基金会临床科研专项资助基金(320.6750.16166);安徽省重点研究与开发计划项目(1804h08020286) |
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| 中文摘要: |
目的 观察肺保护性通气策略对胸腔镜下肺癌根治术患者免疫功能的影响。
方法 择期于全麻下行胸腔镜下肺癌根治术患者60例,男47例,女13例,年龄35～64岁,BMI 18～29 kg/m2,ASA Ⅰ或Ⅱ级,随机分为两组:保护性机械通气组(P组)和传统机械通气组(C组),每组30例。两组均采用容量控制通气模式,保护性机械通气参数:双肺通气时VT 8 ml/kg,RR 12～14次/分;单肺通气时VT 6 ml/kg,RR 14～16次/分,单肺通气期间设定PEEP 5 cmH2O。分别于麻醉诱导前(T0)、术毕(T1)、术后24 h(T2)、术后72 h(T3)采集外周静脉血样,采用流式细胞仪检测外周血T淋巴细胞亚群(CD3+、CD4+、CD8+)、NK细胞数量,计算CD4+/CD8+比值。
结果 与T0时比较,T1和T2时两组CD3+、CD4+和NK细胞明显减少,CD4+/CD8+明显降低(P<0.05)。与P组比较,T1和T2时C组CD3+、CD4+和NK细胞明显减少,CD4+/CD8+明显降低(P<0.05)。与T0时比较,T3时C组CD3+、CD4+和NK细胞明显减少,CD4+/CD8+明显降低(P<0.05),P组CD3+、CD4+、CD4+/CD8+和NK细胞差异无统计学意义。
结论 与传统机械通气相比,肺保护性通气策略可减轻胸腔镜下肺癌根治术患者围术期T淋巴细胞亚群和NK细胞水平下降的程度,减轻术后细胞免疫功能的抑制,细胞免疫功能恢复更快。 |
| 英文摘要: |
Ojective To evaluate the lung protective ventilation strategy on immune function in patients undergoing radical resection of lung cancer.
Methods Sixty patients undergoing thoracoscopic radical resection of lung cancer, 47 males and 13 females, aged 35 - 64 years, BMI 18 - 29 kg/m2, falling into ASA physical status Ⅰ or Ⅱ, were randomly divided into 2 groups with 30 cases in each: conventional mechanical ventilation (group C), protective mechanical ventilation group (group P). Volume-controlled ventilation was performed in the 2 groups. Protective mechanical ventilation mode was setted up as follows: tidal volume (VT) 8 ml/kg and respiratory rate (RR) 12-14 breaths/min during two-lung ventilation (TLV); VT 6 ml/kg, PEEP 5 cmH2O and RR 14-16 breaths/min during one-lung ventilation (OLV). Before induction of anesthesia (T0), at the end of surgery (T1), 24 h after surgery (T2), 72 h after surgery (T3), blood samples were taken from the central venous for determination of peripheral T lymphocyte subsets CD3+, CD4+, CD8+ and NK cell. The CD4+/CD8+ ratio was also calculated.
Results Compared with T0, the percentage of CD3+, CD4+, NK cell and the CD4+/CD8+ ratio was significantly decreased at T1 and T2 in both groups (P<0.05). Compared with group P, the percentage of CD3+, CD4+, NK cell and the CD4+/CD8+ ratio was significantly lower in the group C at T1 and T2 (P < 0.05). Compared with T0, there was no significant difference at T3 with respect of the percentage of CD3+, CD4+, NK cell and the CD4+/CD8+ ratio in the group P while those parameters still lower at T3 in the group C (P < 0.05).
Conclusion Perioperative use of lung protective ventilation strategy could not only alleviate the immune suppression but also make the immune function recover faster in patients undergoing thoracoscopic elective radical resection of lung cancer. |
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