重庆医学2017，Vol.46Issue(29)：4057-4059,3.DOI:10.3969/j.issn.1671-8348.2017.29.008
胸腔镜单肺通气心脏手术与开胸心脏手术肺损伤比较
Comparison of lung injury in patients undergoing thoracoscopic cardiac surgery with one-lung ventilation and thoracotomy
摘要
Abstract
Objective To compare the lung injury in thoracoscopic cardiac surgery with one-lung ventilation (OLV) and thoracotomy cardiac surgery.Methods A total of 60 patients underwent thoracotomy cardiac surgery (control group) or thoracoscopic cardiac surgery with OLV (observation group) in our hospital from May 2013 to December 2015 were enrolled,30 patients in each group.Two-lung ventilation was performed with a single-lumen endotracheal tube in the control group.In observation group,left lung ventilation was performed with a double-lumen endotracheal tube.Arterial blood gas analysis parameters,levels of intercellular adhesion molecule-1 (ICAM-1) and surfactant protein A (SP-A) were detected after the induction of anesthesia (T1),before cardiopulmonary bypass (CPB)(T2),immediately after the onset of the CPB (T3),30 min after CPB (T,) and 60 min after CPB (T5),and the respiratory index (RI) was calculated at the above time points,as well.Lung tissues were collected during operation for nuclear factor-κB (NF-κB) detection and pathological analysis.Results Compared with the control group,arterial partial pressures of oxygen (PaO2) were decreased at T3,T4 and T5,and RI values were increased at T2,T3,T4 and T5 in the observation group(P＜ 0.05).After surgery,the serum levels of ICAM-1 and expression levels of NF-κB in both two groups were increased,and serum levels of SP-A in both two groups were decreased;moreover,the levels of ICAM-1 and NF-κB in the observation group were significantly higher than those in the control group (P＜0.05),and the level of SP-A in the observation group was significantly lower than that in the control group (P＜0.05).The lung histopathological changes showed alveolar swelling,neutrophil infiltration and interstitial exudation in the observation group,and inflammation in the observation group was more obvious than that in the control group.Conclusion Comparing with thoracotomy cardiac surgery,lung injury is more serious in thoracoscopic cardiac surgery with OLV.关键词
胸腔镜检查/心脏手术/单肺通气/体外循环/肺损伤Key words
thoracoscopy/cardiac surgery/one-lung ventilation/extracorporeal circulation/lung injury分类
医药卫生引用本文复制引用
刘毅萍,杜耘,乔欣,杨洪军,张小飞,席文佳,祝文秀,姚小平..胸腔镜单肺通气心脏手术与开胸心脏手术肺损伤比较[J].重庆医学,2017,46(29):4057-4059,3.基金项目
重庆市卫生局医学科研基金资助项目(20130016). （20130016）
