【罂粟摘要】食管切除术保护性单肺通气与常规单肺通气时炎症和肺损伤生物标志物的水平：一项随机临床试验

食管切除术保护性单肺通气与常规单肺通气时炎症和肺损伤生物标志物的水平：一项随机临床试验

翻译：牛振瑛    编辑：佟睿    审校：曹莹

贵州医科大学高鸿教授课题组

背景

在单肺通气过程中，保护性通气是否能减轻机械通气引起的肺部炎症和损伤尚不确定。目的：比较术中保护性通气与传统单肺通气在食管切除术中肺部炎症和肺损伤生物标志物的水平。

设计

随机临床试验。

研究对象

29例在单肺通气下行食道切除手术的患者。

干预措施

实验组采用双肺通气时6ml kg^-1预测体重，单肺通气时3ml kg^-1预测体重，呼气末压力5cmH₂O的小潮气量通气。对照组采用双肺通气时10ml kg^-1预测体重，单肺通气时5ml kg^-1预测体重，无呼气末正压的模式通气。

观察指标

主要观察指标是从通气开始到结束过程中支气管肺泡灌洗液(BAL)中炎性标志物(TNF-a、IL-6和IL-8)和肺损伤标志物(晚期糖基化终产物可溶性受体、表面活性蛋白-D、Clara细胞（终末细支气管上皮中的主要细胞,无纤毛）蛋白16和Ⅱ型肺泡细胞表面抗原)的水平变化。

结果

保护性通气组(n=13)双肺和单肺通气时中位数分别为6.0[5.7~7.8]和3.1[3.0~3.6]mlkg-1预测体重；常规通气组(n=16)在双肺和单肺通气时分别为9.8[7.0~10.1]和5.2[5.0~5.5]mlkg-1预测体重。两组炎症生物标志物的BAL水平从机械通气开始到结束均升高；晚期糖基化终产物可溶性受体、Clara细胞蛋白16和Ⅱ型肺泡细胞表面抗原水平无变化，而表面活性蛋白D水平下降。BAL生物标志物水平的变化在两种通气策略之间没有显著差异。

结论

与常规通气相比，术中保护性通气不影响接受单肺通气食道切除术患者肺部炎症和肺损伤生物标志物水平的变化。

Pulmonary levels of biomarkers for inflammation and lung injury in protective versus conventional one-lung ventilation for oesophagectomy A randomised clinical trial

Abstract

BACKGROUND It is uncertain whether protective ventilation reduces ventilation-induced pulmonary inflammation and injury during one-lung ventilation.

OBJECTIVE To compare intra-operative protective ventilation with conventional during oesophagectomy with respect to pulmonary levels of biomarkers for inflammation and lung injury.

DESIGN Randomised clinical trial.

SETTING Tertiary centre for oesophageal diseases.

PATIENTS Twenty-nine patients scheduled for one-lung ventilation during oesophagectomy.

INTERVENTIONS Low tidal volume (VT) of 6 ml kg^-1 predicted body weight (pbw) during two-lung ventilation and 3 ml kgpbw^-1during one-lung ventilation with 5 cmH2O positive end expired pressure versus intermediate VTof 10 ml kgpbw^-1during two-lung ventilation and 5 ml kgpbw^-1 body weight during one-lung ventilation with no positive end-expiratory pressure.

OUTCOME MEASURES The primary outcome was the change in bronchoalveolar lavage (BAL) levels of preselected biomarkers for inflammation (TNF-a, IL-6 and IL-8) and lung injury (soluble Receptor for Advanced Glycation End-products, surfactant protein-D, Clara Cell protein 16 and Krebs von den Lungen 6), from start to end of ventilation.

RESULTS Median [IQR] VT in the protective ventilation group (n=13) was 6.0 [5.7 to 7.8] and 3.1 [3.0 to 3.6] ml kgpbw^-1during two and one-lung ventilation; VT in the conventional ventilation group (n=16) was 9.8 [7.0 to 10.1] and 5.2 [5.0 to 5.5] ml kgpbw^-1during two and one-lung ventilation. BAL levels of biomarkers for inflammation increased from start to end of ventilation in both groups;levels of soluble Receptor for Advanced Glycation End-products, Clara Cell protein 16 and Krebs von den Lungen 6 did not change, while levels of surfactant protein-D decreased. Changes in BAL biomarkers levels were not significantly different between the two ventilation strategies.

CONCLUSION Intra-operative protective ventilation compared with conventional ventilation does not affect changes in pulmonary levels of biomarkers for inflammation and lung injury in patients undergoing one-lung ventilation for oeso-

phagectomy.