Effect of Low Tidal Volume, Low Tidal Volume Plus Peep and Low Tidal Volume Plus Caap on Inflammatory Factors in One Lung Ventilation

【摘要】：Introduction: A large number of studies have indentified the use of large tidal volumes as a major risk factor for the development of lung injury in mechanically ventilated patient during one lung ventilation. Therefore we have done observation of serum HMGB1, TNF-α, IL-8 concentration changes in one-lung ventilation patients by using low tidal volume, low tidal volume plus PEEP and low tidal volume plus CPAP. Methods: 60 patients of ASA I-II undergoing lobectomy with one lung ventilation were divided into four groups. The four groups are control group (group C, n=15) having tidal volume 10mL/kg, low tidal volume group (group LTV, n=15) having tidal volume 6mL/kg, low tidal volume with positive end expiratory pressure group (group LTV+PEEP, n=15) having tidal volume 6mL/kg with PEEP 5cmH20 and low tidal volume with continuous positive airway pressure group (group LTV+CPAP, n=15) having tidal volume 6mL/kg with CPAP 5cmH_2O. All the patients were induced by general anesthesia and intubated with double lumen tube. After induction of anesthesia blood sample were drawn Immediate (T1), 1 hour after one lung ventilation (T2), 2 hours after one lung ventilation (T3), and 24 hours after surgery (T4). Inflammatory mediators High moblility group box -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 HMGB1, TNF-α, IL-8 were no significant difference at T1 in the other groups (P0.05), but the HMGB1,TNF-α, IL-8 concentration were dramatically increased and showed significance at T2, T3 and T4 (P0.05). Compared with LTV group, in the LTV+ PEEP group and LTV+ CPAP group, the HMGB1,TNFα, IL-8, level were statically significant at T2, T3 and T4 (P0.05). 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 one lung ventilation for thoracic surgery. CPAP and PEEP are useful not only to reduce proinflammatory cytokines but also to treat hypoxia and atelectasis. In the consequence of one lung ventilation, LTV, PEEP, CPAP perhaps more importantly act as a part of protective lung ventilation strategy to prevent lung injury.