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
|
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 18～29kg/m2,ASAⅠ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VT8ml/kg,RR 12～14次/分;单肺通气时VT6ml/kg,RR14～16次/分,单肺通气期间设定PEEP 5cmH2O。分别于麻醉诱导前(T0)、术毕(T1)、术后24h(T2)、术后72h(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。
Objective 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 statusⅠ orⅡ,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 cm H2O and RR 14-16 breaths/min during one-lung ventilation(OLV).Before induction of anesthesia(T0),at the end of surgery(T1),24 hafter surgery(T2),72 hafter 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.
Objective 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 statusⅠ orⅡ,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 cm H2O and RR 14-16 breaths/min during one-lung ventilation(OLV).Before induction of anesthesia(T0),at the end of surgery(T1),24 hafter surgery(T2),72 hafter 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.
引文
[1]Feng C,Feng M,Jiao R,et al.Effect of Dezocine on IL-12and IL-10secretion and lymphocyte activation by culturing dendritic cells from human umbilical cord blood.Eur J Pharmacol,2017,796:110-114.
[2]Dreyfuss D,Saumon G.From ventilator-induced lung injury to multiple organ dysfunction?Intensive Care Med,1998,24(2):102-104.
[3]Plotz FB,Vreugdenhil HA,Slutsky AS,et al.Mechanical ventilation alters the immune response in children without lung pathology.Intensive Care Med,2002,28(4):486-492.
[4]Vreugdenhil HA,Heijnen CJ,Pl9tz FB,et al.Mechanical ventilation of healthy rats suppresses peripheral immune function.Eur Respir J,2004,23(1):122-128.
[5]王南,黄泽清.全身麻醉下肺癌根治术中反比通气与常规通气模式对患者肺泡炎症因子及免疫功能影响.临床军医杂志,2017,45(10):1064-1067.
[6]Lin CY,Zhang H,Cheng KC,et al.Mechanical ventilation may increase susceptibility to the development of bacteremia.Crit Care Med,2003,31(5):1429-1434.
[7]Castellanos EH,Horn L.Immunotherapy in lung cancer.Cancer Treat Res,2016,170:203-223.
[8]卞清明,许仄平,王丽君,等.右美托咪定联合肺保护性通气对胸科手术病人的肺保护作用.中华麻醉学杂志,2017,37(9):1061-1065.
[9]张晓琳,柴小青,王迪.氟比洛芬酯及其联合保护性机械通气对开胸手术病人的肺保护作用.中华麻醉学杂志,2016,36(3):272-276.
[10][10]苏喆,张光明.术前输注氟比洛芬酯对肺癌根治术患者围术期免疫功能及血清β-EP、HMGB1水平的影响.实用药物与临床,2017,20(3):268-271.
[11]辜晓岚,李彭依,顾连兵.地佐辛与芬太尼术后镇痛时妇科恶性肿瘤患者细胞免疫功能的比较.中华麻醉学杂志,2015,35(11):1293-1295.
[12]高艳风,袁伟,丁晓英,等.地佐辛复合氟比洛芬酯术后多模式镇痛对胃癌根治术患者细胞免疫功能的影响。西安交通大学学报(医学版),2014,35(5):669-673,713.
[2]Dreyfuss D,Saumon G.From ventilator-induced lung injury to multiple organ dysfunction?Intensive Care Med,1998,24(2):102-104.
[3]Plotz FB,Vreugdenhil HA,Slutsky AS,et al.Mechanical ventilation alters the immune response in children without lung pathology.Intensive Care Med,2002,28(4):486-492.
[4]Vreugdenhil HA,Heijnen CJ,Pl9tz FB,et al.Mechanical ventilation of healthy rats suppresses peripheral immune function.Eur Respir J,2004,23(1):122-128.
[5]王南,黄泽清.全身麻醉下肺癌根治术中反比通气与常规通气模式对患者肺泡炎症因子及免疫功能影响.临床军医杂志,2017,45(10):1064-1067.
[6]Lin CY,Zhang H,Cheng KC,et al.Mechanical ventilation may increase susceptibility to the development of bacteremia.Crit Care Med,2003,31(5):1429-1434.
[7]Castellanos EH,Horn L.Immunotherapy in lung cancer.Cancer Treat Res,2016,170:203-223.
[8]卞清明,许仄平,王丽君,等.右美托咪定联合肺保护性通气对胸科手术病人的肺保护作用.中华麻醉学杂志,2017,37(9):1061-1065.
[9]张晓琳,柴小青,王迪.氟比洛芬酯及其联合保护性机械通气对开胸手术病人的肺保护作用.中华麻醉学杂志,2016,36(3):272-276.
[10][10]苏喆,张光明.术前输注氟比洛芬酯对肺癌根治术患者围术期免疫功能及血清β-EP、HMGB1水平的影响.实用药物与临床,2017,20(3):268-271.
[11]辜晓岚,李彭依,顾连兵.地佐辛与芬太尼术后镇痛时妇科恶性肿瘤患者细胞免疫功能的比较.中华麻醉学杂志,2015,35(11):1293-1295.
[12]高艳风,袁伟,丁晓英,等.地佐辛复合氟比洛芬酯术后多模式镇痛对胃癌根治术患者细胞免疫功能的影响。西安交通大学学报(医学版),2014,35(5):669-673,713.