Effect of Low Tidal Volume,Low Tidal Volume Plus Peep and Low Tidal Volume Plus Cpap on Inflammatory Factors in ONE Lung Ventilation

摘要

Introduction: A large number of studies have indentified the use of largetidal volumes as a major risk factor for the development of lung injury inmechanically ventilated patient during one lung ventilation. Therefore wehave done observation of serum HMGBl, TNF-α, IL-8 concentrationchanges in one-lung ventilation patients by using low tidal volume, lowtidal volume plus PEEP and low tidal volume plus CPAP.
　　Methods: 60 patients of ASA I-II undergoing lobectomy with one lungventilation were divided into four groups. The four gioups are controlgroup (group C, n=15) having tidal volume lOmL/kg, low tidal volumegroup (group LTV, n=15) having tidal volume 6mL/kg, low tidal volumewith positive end expiratory pressure group (group LTV+PEEP, n=15)having tidal volume 6mL/kg with PEEP 5cmH2O and low tidal volume withcontinuous positive airway pressure group (group LTV+CPAP, n=15)having tidal volume 6mL/kg with CPAP 5cmH2O. All the patients wereinduced by general anesthesia and intubated with double lumen tube. Afterinduction of anesthesia blood sample were drawn Immediate (T1), 1 hourafier one lung ventilation (T2), 2 hours after one lung ventilation (T3), and24 hours after surgery (T4). Inflammatory mediators High moblility groupbox -1 (HMGB1), Tumor necrosis factor-α(TNF-α), Interleukin8 (IL-8)and blood gas analysis was done at several time points.
　　Results: Compared with control group, the concentration of HMGBl,TNF-α, IL-8 were no significant difference at Tl in the other groups(P>0.05), but the HMGBl, TNF-a, IL-8 concentration were dramaticallyincreased and showed significance at T2, T3 and T4 (P<0.05). Comparedwith LTV group, in the LTV+ PEEP group and LTV+ CPAP group, theHMGBl,TNFα, IL-8, level were statically significant at T2, T3 and T4(P<0.05). The number of composite adverse events was lower in the LTV,LTV+PEEP and LTV+CPAP group.
　　Conclusion: This study suggests that low tidal volume, low tidal volume +PEEP and CPAP decrease the HMGB1, TNF-αand IL-8 under going onelung ventilation for thoracic surgery, CPAP and PEEP are useful not only toreduce proinflammatory cytokines but also to treat hypoxia and atelectasis.In the consequence of one lung ventilation, LTV, PEEP, CPAP perhapsmore importantly act as a part of protective lung ventilation strategy toprevent lung injury.