Objective To approach the effect of protective mechanical ventilation on acute lung injury after orthotopic liver transplantation, by observing changes of plasma markers of lung injury and inflammatory mediators.Methods Sixty patients scheduled for liver transplantation under general anesthesia, 42 males and 18 females, aged 21-62 years, weighing 43-80 kg, ASA physical status Ⅱ-Ⅳ, were randomly divided into 2 groups: protective mechanical ventilation group (group P) and unprotective mechanical ventilation group (group U).Pulmonary artery blood for plasma markers of lung injury and inflammatory mediators were collected at the following time points: before operation (T1), 3 hours after mechanical ventilation (T2), 2 hours (T3) and 4 hours in neohepatic stage (T4).These mediators included clara cell secretory protein (CC16), surfactant proteins (SP-D), soluble receptor for advanced glycation end-products (sRAGE), TNF-α, IL-6 and IL-8.Moreover, blood gas results were recorded at these 7 time points: T1-T4, 2 hours after operation (T5), before tracheal extubation (T6) and 2 days after operation (T7).The postoperative awakening time, tracheal extubation time, ICU stay time and the incidence of ALI were recorded.Results Compared with T1, plasma level of CC16 in the two groups increased at T2 and T3 (P<0.05 or P<0.01), however, plasma level of SP-D, sRAGE, TNF-α, IL-6 and IL-8 did not increase until T3 (P<0.01).Moreover, plasma level of sRAGE, TNF-α, IL-6 and IL-8 at T4 were higher than those at T1 (P<0.05 or P<0.01).Compared with T1, OIs in the two groups increased at T2, T5 and T6 (P<0.05 or P<0.01), while decreased at T4 in group P (P<0.01) and at T3 and T4 in group U (P<0.01).In group P, patients showed a lower plasma level of CC16 at T2 and T3 (P<0.05 or P<0.01), a higher OI at T3 (P<0.05) and an earlier tracheal extubation after operation [(8.9±3.2) h vs (9.3±2.8) h, P<0.05] compared with group U.There was no significant difference of acute lung injury incidence between the two groups after operation, which was 5(16.6%) and 7 (23.3%), respectively.Conclusion Protective mechanical ventilation may promote oxygenation index, and shorten tracheal extubation time, thus protect lung function of patients in liver transplantation to some extend.%目的 观察肺保护性通气对肝移植手术患者肺损伤血清生物标志物和炎性因子的影响,探讨其对肝移植术后急性肺损伤(acute lung injury,ALI)的影响.方法 选择行原位肝移植术的终末期肝病患者60例,男42例,女18例,年龄21~62岁,体重43~80 kg,ASA Ⅱ~Ⅳ级.随机分为肺保护性通气组(P组)和非肺保护性通气组(U组),每组30例.所有患者分别于麻醉后手术开始前(T1)、机械通气3 h(T2)、新肝期2 h(T3)及新肝期4 h (T4)检测肺动脉血中肺损伤血清生物标志物和炎性因子的水平,包括克拉拉细胞分泌蛋白16(CC16)、表面活性蛋白(SP-D)及高级糖基化终末产物可溶性受体(sRAGE)、TNF-α、IL-6及IL-8;于T1~T4、术后2 h(T5)、拔管前(T6)及术后2 d(T7)行桡动脉血血气分析.记录患者术后清醒时间、拔管时间、ICU停留时间及ALI的发生情况.结果 与T1时比较,T2~T4时两组血清CC16浓度明显升高(P<0.05或P<0.01);T3时两组SP-D、sRAGE、TNF-α、IL-6及IL-8浓度明显升高(P<0.01);T4时sRAGE、TNF-α、IL-6和IL-8浓度明显升高(P<0.05或P<0.01);T2、T5、T6时两组氧合指数(OI)明显升高(P<0.05或P<0.01),T4时P组明显降低(P<0.01),T3、T4时U组明显降低(P<0.01).T2、T3时P组CC16浓度明显低于U组(P<0.05或P<0.01);T3时P组OI明显高于U组(P<0.05);P组术后拔管时间明显短于U组[(8.9±3.2)h vs (9.3±2.8)h,P<0.05].P组术后ALI 5例(16.6%),U组术后ALI 7例(23.3%),两组差异无统计学意义.结论 肺保护性通气可改善肝移植手术患者的氧合指数,缩短拔管时间,减轻肺损伤.
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