摘要
目的 评价长时间单肺通气患者非通气侧肺损伤时巨噬细胞状态的变化.方法 选取择期行肺叶切除术的肺癌患者30例,性别不限,年龄35～64岁,体重50～ 80 kg,ASA分级Ⅰ或Ⅱ级.根据单肺通气时间分为2组（n=15）：短时间单肺通气组（＜30 min,S组）和长时间单肺通气组（＞2h,L组）.常规全身麻醉诱导和麻醉维持.切取切除肺叶肿瘤周边正常的肺组织,光镜下观察病理学结果,并行肺损伤评分;免疫荧光法检测肺组织中活化的巨噬细胞（CD68阳性）、极化的M1型巨噬细胞（CD86阳性）和极化的M2型巨噬细胞（CD206阳性）的细胞数,并计算CD86阳性细胞数与CD206阳性细胞数的比值.结果 与S组比较,L组非通气侧肺损伤评分升高,肺组织CD68阳性、CD86阳性和CD206阳性表达的细胞数增多,CD86阳性细胞数与CD206阳性细胞数的比值升高（P＜0.05）.结论 长时间（＞2 h）单肺通气可引起非通气侧肺组织中活化的巨噬细胞增多,且以向M1型巨噬细胞极化为主,这可能是单肺通气非通气侧肺损伤的机制之一.
Objective To evaluate the changes in the status of macrophages during the non-ventilated lung injury in the patients undergoing long-time one-lung ventilation （OLV）.Methods Thirty patients of both sexes,aged 35-64 yr,weighing 50-80 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective pulmonary lobectomy for lung cancer,were divided into 2 groups （n=15 each） according to the time of OLV：short-time OLV group （〈30 min,group S） and long-time OLV group （〉2 h,group L）.Anesthesia was routinely induced and maintained.Normal lung tissues around the cancer tissues from the lobe of the lung excised were obtained for microscopic examination of pathologic changes which were scored.The activated macrophages （CD68 positive）,polarized M1 macrophages （CD86 positive） and polarized M2 macrophages （CD206 positive） in lung tissues were detected using immunofluorescence.The ratio of CD86 positive cells to CD206 positive cells was calculated.Results Compared with group S,lung injury scores on the non-ventilated side were significantly increased,the number of CD68,CD86 and CD206 positive cells in lung tissues was increased,and the ratio of CD86 positive cells to CD206 positive cells was increased in group L （P〈0.05）.Conclusion Long-time OLV （〉2 h） can result in increased number of activated macrophages,especially the polarized M1 macrophages,which may be one of the mechanisms underlying lung injury on the non-ventilated side.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2017年第1期39-42,共4页
Chinese Journal of Anesthesiology
关键词
呼吸
人工
呼吸窘迫综合征
成人
巨噬细胞
肺泡
Respiration,artificial
Respiratory distress syndrome,adult
Macrophages,alveolar
