胸科手术与肺损伤的防治_West China Medical Journal

Authors：

 王茂华 ^1,2 , 牧杰 ¹ , 王文建 ¹ ,  王儒蓉 ¹

1. ;
2. ;

Corresponding author：

王儒蓉, Email: 576950028@qq.com

Keywords：

胸科手术; 急性肺损伤; 机械通气

DOI：

10.7507/1002-0179.20140658

Video：

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Abstract Full text Figures/Tables Video References Cited by

急性肺损伤是胸科手术后主要的并发症之一。围手术期多种因素参与了术后急性肺损伤的发生。机械通气、高潮气量、不同的通气模式及吸入氧浓度、术中输液等均可能对胸科手术后肺损伤产生影响。现就胸科手术与肺损伤的防治作一综述。

Citation： 王茂华, 牧杰, 王文建, 王儒蓉. 胸科手术与肺损伤的防治. West China Medical Journal, 2014, 29(11): 2178-2182. doi: 10.7507/1002-0179.20140658 Copy

1.	Peñuelas O, Aramburu JA, Frutos-Vivar F, et al. Pathology of acute lung injury and acute respiratory distress syndrome:a clinical-pathological correlation[J]. Clin Chest Med, 2006, 27(4):571-578.
2.	Galani V, Tatsaki E, Bai M, et al. The role of apoptosis in the pathophysiology of acute respiratory distress syndrome (ARDS):an up-to-date cell-specific review[J]. Pathol Res Pract, 2010, 206(3):145-150.
3.	齐战, 朱德成, 陈万生, 等. 胸胃对食管癌围术期呼吸功能的影响[J]. 中华胸心血管外科杂志, 2000, 16(3):150-152.
4.	Wolthuis EK, Choi G, Dessing MC, et al. Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents pulmonary inflammation in patients without preexisting lung injury[J]. Anesthesiology, 2008, 108(1):46-54.
5.	Kozian A, Schilling T, Fredén F, et al. One-lung ventilation induces hyperperfusion and alveolar damage in the ventilated lung:an experimental study[J]. Br J Anaesth, 2008, 100(4):549-559.
6.	Gothard J. Lung injury after thoracic surgery and one-lung ventilation[J]. Curr Opin Anaesthesiol, 2006, 19(1):5-10.
7.	Sekido N, Mukaida N, Harada A, et al. Prevention of lung reperfusion injury in rabbits by a monoclonal antibody against interleukin-8[J]. Nature, 1993, 365(6447):654-657.
8.	Kilpatrick B, Slinger P. Lung protective strategies in anaesthesia[J]. Br J Anaesth, 2010, 105(Suppl 1):i108-i116.
9.	Schilling T, Kozian A, Huth C, et al. The pulmonary immune effects of mechanical ventilation in patients undergoing thoracic surgery[J]. Anesth Analg, 2005, 101(4):957-965.
10.	Gama De Abreu M, Heintz M, Heller A, et al. One-lung ventilation with high tidal volumes and zero positive end-expiratory pressure is injurious in the isolated rabbit lung model[J]. Anesth Analg, 2003, 96(1):220-228.
11.	Michelet P, D'journo XB, Roch A, et al. Protective ventilation influences systemic inflammation after esophagectomy:a randomized controlled study[J]. Anesthesiology, 2006, 105(5):911-919.
12.	Szegedi LL, Bardoczky GI, Engelman EE, et al. Airway pressure changes during one-lung ventilation[J]. Anesth Analg, 1997, 84(5):1034-1037.
13.	Kawati R, Lattuada M, Sjöstrand U, et al. Peak airway pressure increase is a late warning sign of partial endotracheal tube obstruction whereas change in expiratory flow is an early warning sign[J]. Anesth Analg, 2005, 100(3):889-893.
14.	van der Werff YD, van der Houwen HK, Heijmans PJ, et al. Postpneumonectomy pulmonary edema. A retrospective analysis of incidence and possible risk factors[J]. Chest, 1997, 111(5):1278-1284.
15.	Licker M, De Perrot M, Spiliopoulos A, et al. Risk factors for acute lung injury after thoracic surgery for lung cancer[J]. Anesth Analg, 2003, 97(6):1558-1565.
16.	Esteban A, Alía I, Gordo F, et al. Prospective randomized trial comparing pressure-controlled ventilation and volume-controlled ventilation in ARDS. For the Spanish Lung Failure Collaborative Group[J]. Chest, 2000, 117(6):1690-1696.
17.	Macintyre NR. Setting the frequency-tidal volume pattern[J]. Respir Care, 2002, 47(3):266-274.
18.	Maeda Y, Fujino Y, Uchiyama A, et al. Effects of peak inspiratory flow on development of ventilator-induced lung injury in rabbits[J]. Anesthesiology, 2004, 101(3):722-728.
19.	Campbell RS, Davis BR. Pressure-controlled versus volume-controlled ventilation:does it matter?[J]. Respir Care, 2002, 47(4):416-424.
20.	Ducros L, Moutafis M, Castelain MH, et al. Pulmonary air trapping during two-lung and one-lung ventilation[J]. J Cardiothorac Vasc Anesth, 1999, 13(1):35-39.
21.	Unzueta MC, Casas JI, Moral MV. Pressure-controlled versus volume-controlled ventilation during one-lung ventilation for thoracic surgery[J]. Anesth Analg, 2007, 104(5):1029-1033.
22.	Grichnik KP, Shaw A. Update on one-lung ventilation:the use of continuous positive airway pressure ventilation and positive end-expiratory pressure ventilation-clinical application[J]. Curr Opin Anaesthesiol, 2009, 22(1):23-30.
23.	Tschumperlin DJ, Oswari J, Margulies AS. Deformation-induced injury of alveolar epithelial cells. Effect of frequency, duration, and amplitude[J]. Am J Respir Crit Care Med, 2000, 162(2 Pt 1):357-362.
24.	Tschumperlin DJ, Margulies SS. Alveolar epithelial surface area-volume relationship in isolated rat lungs[J]. J Appl Physiol, 1999, 86(6):2026-2033.
25.	Pecchiari M, Monaco A, Koutsoukou A, et al. Plasma membrane disruptions with different modes of injurious mechanical ventilation in normal rat lungs[J]. Crit Care Med, 2012, 40(3):869-875.
26.	Leong LM, Chatterjee S, Gao F. The effect of positive end expiratory pressure on the respiratory profile during one-lung ventilation for thoracotomy[J]. Anaesthesia, 2007, 62(1):23-26.
27.	Slinger PD, Hickey DR. The interaction between applied PEEP and auto-PEEP during one-lung ventilation[J]. J Cardiothorac Vasc Anesth, 1998, 12(2):133-136.
28.	Slinger PD, Kruger M, Mcrae K, et al. Relation of the static compliance curve and positive end-expiratory pressure to oxygenation during one-lung ventilation[J]. Anesthesiology, 2001, 95(5):1096-1102.
29.	Valenza F, Ronzoni G, Perrone L, et al. Positive end-expiratory pressure applied to the dependent lung during one-lung ventilation improves oxygenation and respiratory mechanics in patients with high FEV1[J]. Eur J Anaesthesiol, 2004, 21(12):938-943.
30.	Rozé H, Lafargue M, Ouattara A. Case scenario:management of intraoperative hypoxemia during one-lung ventilation[J]. Anesthesiology, 2011, 114(1):167-174.
31.	Karzai W, Schwarzkopf K. Hypoxemia during one-lung ventilation:prediction, prevention, and treatment[J]. Anesthesiology, 2009, 110(6):1402-1411.
32.	Hoftman N, Canales C, Leduc M, et al. Positive end expiratory pressure during one-lung ventilation:selecting ideal patients and ventilator settings with the aim of improving arterial oxygenation[J]. Ann Card Anaesth, 2011, 14(3):183-187.
33.	Pelosi P1, Rocco PR, de Abreu MG. Use of computed tomography scanning to guide lung recruitment and adjust positive-end expiratory pressure[J]. Curr Opin Crit Care, 2011, 17(3):268-274.
34.	Kim YD, Ko S, Kim D, et al. The effects of incremental continuous positive airway pressure on arterial oxygenation and pulmonary shunt during one-lung ventilation[J]. Korean J Anesthesiol, 2012, 62(3):256-259.
35.	Sentürk M, Layer M, Pembeci K, et al. A comparison of the effects of 50% oxygen combined with CPAP to the non-ventilated lung vs. 100% oxygen on oxygenation during one-lung ventilation[J]. Anasthesiol Intensivmed Notfallmed Schmerzther, 2004, 39(6):360-364.
36.	Cohen E. Management of one-lung ventilation[J]. Anesthesiol Clin North America, 2001, 19(3):475-495.
37.	Greif R, Akça O, Horn EP, et al. Supplemental perioperative Oxygen to reduce the incidence of surgical-wound infection[J]. N Engl J Med, 2000, 342(3):161-167.
38.	Goll V, Akça O, Greif R, et al. Ondansetron is no more effective than supplemental intraoperative Oxygen for prevention of postoperative nausea and vomiting[J]. Anesth Analg, 2001, 92(1):112-117.
39.	Kotani N, Hashimoto H, Sessler DI, et al. Supplemental intraoperative Oxygen augments antimicrobial and proinflammatory responses of alveolar macrophages[J]. Anesthesiology, 2000, 93(1):15-25.
40.	Magnusson L, Spahn DR. New concepts of atelectasis during general anaesthesia[J]. Br J Anaesth, 2003, 91(1):61-72.
41.	Lytle FT, Brown DR. Appropriate ventilatory settings for thoracic surgery:intraoperative and postoperative[J]. Semin Cardiothorac Vasc Anesth, 2008, 12(2):97-108.
42.	Her C, Mandy S. Acute respiratory distress syndrome of the contralateral lung after reexpansion pulmonary edema of a collapsed lung[J]. J Clin Anesth, 2004, 16(4):244-250.
43.	Cheng YJ, Chan KC, Chien CT, et al. Oxidative stress during 1-lung ventilation[J]. J Thorac Cardiovasc Surg, 2006, 132(3):513-518.
44.	Licker M, Fauconnet P, Villiger Y, et al. Acute lung injury and outcomes after thoracic surgery[J]. Curr Opin Anaesthesiol, 2009, 22(1):61-67.
45.	Della Rocca G, Coccia C. Ventilatory management of one-lung ventilation[J]. Minerva Anestesiol, 77(5):534-536.
46.	Lobo DN, Bostock KA, Neal KR, et al. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection:a randomised controlled trial[J]. Lancet, 2002, 359(9320):1812-1818.
47.	Brandstrup B, Tønnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications:comparison of two perioperative fluid regimens:a randomized assessor-blinded multicenter trial[J]. Ann Surg, 2003, 238(5):641-648.
48.	Nisanevich V, Felsenstein I, Almogy G, et al. Effect of intraoperative fluid management on outcome after intraabdominal surgery[J]. Anesthesiology, 2005, 103(1):25-32.
49.	Joshi PG. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery[J]. Anesth Analg, 2005, 101(2):601-605.
50.	Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess[J]. Br J Anaesth, 2002, 89(4):622-632.
51.	Kita T, Mammoto T, Kishi Y. Fluid management and postoperative respiratory disturbances in patients with transthoracic esophagectomy for carcinoma[J]. J Clin Anesth, 2002, 14(4):252-256.
52.	Khoo CK, Vickery CJ, Forsyth N, et al. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer[J]. Ann Surg, 2007, 245(6):867-872.
53.	Bundgaard-Nielsen M, Holte K, Secher NH, et al. Monitoring of peri-operative fluid administration by individualized goal-directed therapy[J]. Acta Anaesthesiol Scand, 2007, 51(3):331-340.
54.	Marjanovic G, Villain C, Timme S, et al. Colloid vs[J]. Colloid vs. crystalloid infusions in gastrointestinal surgery and their different impact on the healing of intestinal anastomoses[J]. Int J Colorectal Dis, 2010, 25(4):491-498.
55.	Chappell D, Jacob M, Hofmann-Kiefer KA, et al. A rational approach to perioperative fluid management[J]. Anesthesiology, 2008, 109(4):723-740.

1. Peñuelas O, Aramburu JA, Frutos-Vivar F, et al. Pathology of acute lung injury and acute respiratory distress syndrome:a clinical-pathological correlation[J]. Clin Chest Med, 2006, 27(4):571-578.
2. Galani V, Tatsaki E, Bai M, et al. The role of apoptosis in the pathophysiology of acute respiratory distress syndrome (ARDS):an up-to-date cell-specific review[J]. Pathol Res Pract, 2010, 206(3):145-150.
3. 齐战, 朱德成, 陈万生, 等. 胸胃对食管癌围术期呼吸功能的影响[J]. 中华胸心血管外科杂志, 2000, 16(3):150-152.
4. Wolthuis EK, Choi G, Dessing MC, et al. Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents pulmonary inflammation in patients without preexisting lung injury[J]. Anesthesiology, 2008, 108(1):46-54.
5. Kozian A, Schilling T, Fredén F, et al. One-lung ventilation induces hyperperfusion and alveolar damage in the ventilated lung:an experimental study[J]. Br J Anaesth, 2008, 100(4):549-559.
6. Gothard J. Lung injury after thoracic surgery and one-lung ventilation[J]. Curr Opin Anaesthesiol, 2006, 19(1):5-10.
7. Sekido N, Mukaida N, Harada A, et al. Prevention of lung reperfusion injury in rabbits by a monoclonal antibody against interleukin-8[J]. Nature, 1993, 365(6447):654-657.
8. Kilpatrick B, Slinger P. Lung protective strategies in anaesthesia[J]. Br J Anaesth, 2010, 105(Suppl 1):i108-i116.
9. Schilling T, Kozian A, Huth C, et al. The pulmonary immune effects of mechanical ventilation in patients undergoing thoracic surgery[J]. Anesth Analg, 2005, 101(4):957-965.
10. Gama De Abreu M, Heintz M, Heller A, et al. One-lung ventilation with high tidal volumes and zero positive end-expiratory pressure is injurious in the isolated rabbit lung model[J]. Anesth Analg, 2003, 96(1):220-228.
11. Michelet P, D'journo XB, Roch A, et al. Protective ventilation influences systemic inflammation after esophagectomy:a randomized controlled study[J]. Anesthesiology, 2006, 105(5):911-919.
12. Szegedi LL, Bardoczky GI, Engelman EE, et al. Airway pressure changes during one-lung ventilation[J]. Anesth Analg, 1997, 84(5):1034-1037.
13. Kawati R, Lattuada M, Sjöstrand U, et al. Peak airway pressure increase is a late warning sign of partial endotracheal tube obstruction whereas change in expiratory flow is an early warning sign[J]. Anesth Analg, 2005, 100(3):889-893.
14. van der Werff YD, van der Houwen HK, Heijmans PJ, et al. Postpneumonectomy pulmonary edema. A retrospective analysis of incidence and possible risk factors[J]. Chest, 1997, 111(5):1278-1284.
15. Licker M, De Perrot M, Spiliopoulos A, et al. Risk factors for acute lung injury after thoracic surgery for lung cancer[J]. Anesth Analg, 2003, 97(6):1558-1565.
16. Esteban A, Alía I, Gordo F, et al. Prospective randomized trial comparing pressure-controlled ventilation and volume-controlled ventilation in ARDS. For the Spanish Lung Failure Collaborative Group[J]. Chest, 2000, 117(6):1690-1696.
17. Macintyre NR. Setting the frequency-tidal volume pattern[J]. Respir Care, 2002, 47(3):266-274.
18. Maeda Y, Fujino Y, Uchiyama A, et al. Effects of peak inspiratory flow on development of ventilator-induced lung injury in rabbits[J]. Anesthesiology, 2004, 101(3):722-728.
19. Campbell RS, Davis BR. Pressure-controlled versus volume-controlled ventilation:does it matter?[J]. Respir Care, 2002, 47(4):416-424.
20. Ducros L, Moutafis M, Castelain MH, et al. Pulmonary air trapping during two-lung and one-lung ventilation[J]. J Cardiothorac Vasc Anesth, 1999, 13(1):35-39.
21. Unzueta MC, Casas JI, Moral MV. Pressure-controlled versus volume-controlled ventilation during one-lung ventilation for thoracic surgery[J]. Anesth Analg, 2007, 104(5):1029-1033.
22. Grichnik KP, Shaw A. Update on one-lung ventilation:the use of continuous positive airway pressure ventilation and positive end-expiratory pressure ventilation-clinical application[J]. Curr Opin Anaesthesiol, 2009, 22(1):23-30.
23. Tschumperlin DJ, Oswari J, Margulies AS. Deformation-induced injury of alveolar epithelial cells. Effect of frequency, duration, and amplitude[J]. Am J Respir Crit Care Med, 2000, 162(2 Pt 1):357-362.
24. Tschumperlin DJ, Margulies SS. Alveolar epithelial surface area-volume relationship in isolated rat lungs[J]. J Appl Physiol, 1999, 86(6):2026-2033.
25. Pecchiari M, Monaco A, Koutsoukou A, et al. Plasma membrane disruptions with different modes of injurious mechanical ventilation in normal rat lungs[J]. Crit Care Med, 2012, 40(3):869-875.
26. Leong LM, Chatterjee S, Gao F. The effect of positive end expiratory pressure on the respiratory profile during one-lung ventilation for thoracotomy[J]. Anaesthesia, 2007, 62(1):23-26.
27. Slinger PD, Hickey DR. The interaction between applied PEEP and auto-PEEP during one-lung ventilation[J]. J Cardiothorac Vasc Anesth, 1998, 12(2):133-136.
28. Slinger PD, Kruger M, Mcrae K, et al. Relation of the static compliance curve and positive end-expiratory pressure to oxygenation during one-lung ventilation[J]. Anesthesiology, 2001, 95(5):1096-1102.
29. Valenza F, Ronzoni G, Perrone L, et al. Positive end-expiratory pressure applied to the dependent lung during one-lung ventilation improves oxygenation and respiratory mechanics in patients with high FEV1[J]. Eur J Anaesthesiol, 2004, 21(12):938-943.
30. Rozé H, Lafargue M, Ouattara A. Case scenario:management of intraoperative hypoxemia during one-lung ventilation[J]. Anesthesiology, 2011, 114(1):167-174.
31. Karzai W, Schwarzkopf K. Hypoxemia during one-lung ventilation:prediction, prevention, and treatment[J]. Anesthesiology, 2009, 110(6):1402-1411.
32. Hoftman N, Canales C, Leduc M, et al. Positive end expiratory pressure during one-lung ventilation:selecting ideal patients and ventilator settings with the aim of improving arterial oxygenation[J]. Ann Card Anaesth, 2011, 14(3):183-187.
33. Pelosi P1, Rocco PR, de Abreu MG. Use of computed tomography scanning to guide lung recruitment and adjust positive-end expiratory pressure[J]. Curr Opin Crit Care, 2011, 17(3):268-274.
34. Kim YD, Ko S, Kim D, et al. The effects of incremental continuous positive airway pressure on arterial oxygenation and pulmonary shunt during one-lung ventilation[J]. Korean J Anesthesiol, 2012, 62(3):256-259.
35. Sentürk M, Layer M, Pembeci K, et al. A comparison of the effects of 50% oxygen combined with CPAP to the non-ventilated lung vs. 100% oxygen on oxygenation during one-lung ventilation[J]. Anasthesiol Intensivmed Notfallmed Schmerzther, 2004, 39(6):360-364.
36. Cohen E. Management of one-lung ventilation[J]. Anesthesiol Clin North America, 2001, 19(3):475-495.
37. Greif R, Akça O, Horn EP, et al. Supplemental perioperative Oxygen to reduce the incidence of surgical-wound infection[J]. N Engl J Med, 2000, 342(3):161-167.
38. Goll V, Akça O, Greif R, et al. Ondansetron is no more effective than supplemental intraoperative Oxygen for prevention of postoperative nausea and vomiting[J]. Anesth Analg, 2001, 92(1):112-117.
39. Kotani N, Hashimoto H, Sessler DI, et al. Supplemental intraoperative Oxygen augments antimicrobial and proinflammatory responses of alveolar macrophages[J]. Anesthesiology, 2000, 93(1):15-25.
40. Magnusson L, Spahn DR. New concepts of atelectasis during general anaesthesia[J]. Br J Anaesth, 2003, 91(1):61-72.
41. Lytle FT, Brown DR. Appropriate ventilatory settings for thoracic surgery:intraoperative and postoperative[J]. Semin Cardiothorac Vasc Anesth, 2008, 12(2):97-108.
42. Her C, Mandy S. Acute respiratory distress syndrome of the contralateral lung after reexpansion pulmonary edema of a collapsed lung[J]. J Clin Anesth, 2004, 16(4):244-250.
43. Cheng YJ, Chan KC, Chien CT, et al. Oxidative stress during 1-lung ventilation[J]. J Thorac Cardiovasc Surg, 2006, 132(3):513-518.
44. Licker M, Fauconnet P, Villiger Y, et al. Acute lung injury and outcomes after thoracic surgery[J]. Curr Opin Anaesthesiol, 2009, 22(1):61-67.
45. Della Rocca G, Coccia C. Ventilatory management of one-lung ventilation[J]. Minerva Anestesiol, 77(5):534-536.
46. Lobo DN, Bostock KA, Neal KR, et al. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection:a randomised controlled trial[J]. Lancet, 2002, 359(9320):1812-1818.
47. Brandstrup B, Tønnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications:comparison of two perioperative fluid regimens:a randomized assessor-blinded multicenter trial[J]. Ann Surg, 2003, 238(5):641-648.
48. Nisanevich V, Felsenstein I, Almogy G, et al. Effect of intraoperative fluid management on outcome after intraabdominal surgery[J]. Anesthesiology, 2005, 103(1):25-32.
49. Joshi PG. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery[J]. Anesth Analg, 2005, 101(2):601-605.
50. Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess[J]. Br J Anaesth, 2002, 89(4):622-632.
51. Kita T, Mammoto T, Kishi Y. Fluid management and postoperative respiratory disturbances in patients with transthoracic esophagectomy for carcinoma[J]. J Clin Anesth, 2002, 14(4):252-256.
52. Khoo CK, Vickery CJ, Forsyth N, et al. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer[J]. Ann Surg, 2007, 245(6):867-872.
53. Bundgaard-Nielsen M, Holte K, Secher NH, et al. Monitoring of peri-operative fluid administration by individualized goal-directed therapy[J]. Acta Anaesthesiol Scand, 2007, 51(3):331-340.
54. Marjanovic G, Villain C, Timme S, et al. Colloid vs[J]. Colloid vs. crystalloid infusions in gastrointestinal surgery and their different impact on the healing of intestinal anastomoses[J]. Int J Colorectal Dis, 2010, 25(4):491-498.
55. Chappell D, Jacob M, Hofmann-Kiefer KA, et al. A rational approach to perioperative fluid management[J]. Anesthesiology, 2008, 109(4):723-740.

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