CAJ | 학술논문

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)表达的影响.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～O5组建立右肺OLV,分别给予OLV1、2、3、4、5h.各组中5只兔子完成OLV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值均升高大于101.90±18.65(P＜0.01),O4～O5组左肺IL-8值升高大于256.16±30.32(P＜0.01),O5组右肺TNF-α、IL-8值升高(P＜0.01).24h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24h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表达均大于13.84±3.47(P＜0.01)、O1～O5组右肺SP-A表达均大于5.51±1.48 (P＜0.01),O4～O5组SP-A表达减少;24h后O1～05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3h,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.
목적 관찰불동시간단폐통기(one lung ventilation,OLV)대토지기관폐포관세액중종류배사인자-α(tumor necrosis factor-α,TNF-α)화백개소-8(interleukin-8,IL-8),이급폐조직표면활성단백-A(surfactant protein-A,SP-A)표체적영향.방법 선택신서란대백토60지.안완전수궤분조방법수궤균분위C조화O1、O2、O3、O4、O5조(매조10지).O1～O5조건립우폐OLV,분별급여OLV1、2、3、4、5h.각조중5지토자완성OLV후립즉처사,령5지토자발제각충관도자연양활24 h,분별측정좌우폐관세액중세포수、TNF-α、IL-8농도화폐조직SP-A.결과 OLV시,여C조비교,O3～O5조좌우폐세포수균대우4.64±0.79 (P＜0.01);O4화O5조이양화탄분압(PaCO2)고우43.6±5.7 (P＜0.01);O3～O5조좌폐TNF-α치균승고대우101.90±18.65(P＜0.01),O4～O5조좌폐IL-8치승고대우256.16±30.32(P＜0.01),O5조우폐TNF-α、IL-8치승고(P＜0.01).24h후,O4～O5조좌폐세포수잉고우7.5±1.9(P＜0.01);좌폐IL-8치재O5조위214.60±76.74 (P＜0.01).좌폐여우폐간적TNF-α화IL-8치재OLV시여24h후각시점비교균무통계학차이(P＞0.05).여C조비교,O1～O3조좌폐SP-A표체균대우13.84±3.47(P＜0.01)、O1～O5조우폐SP-A표체균대우5.51±1.48 (P＜0.01),O4～O5조SP-A표체감소;24h후O1～05조좌우폐SP-A표체균대우12.17±4.75(P＜0.01).결론 수착OLV시간연장,폐염증반응명현급폐SP-A표체감소;재OLV초과3h,즉사회복쌍폐통기24 h후,폐손상잉난이완전수복,응피면OLV시간과장.
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 fight 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 SP-A 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-8in right lung of group O4-O5 increased 256.16±30.32(P＜0.01 ).24 h 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＜O.O1),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.