ABSTRACT
Objective To investigate the effects of selective lobar ventilation on intrapulmonary shunt and inflammatory response in patients with pulmonary dysfunction during thoracotomy.Methods Thirty-four ASA Ⅱ or Ⅲ patients,aged 64-79 years,weighing 50-85 kg,with moderate or severe impaired pulmonary function,scheduled for esophageal cancer radical correction,were randomly divided into two groups (n =17 each):one-lung ventilation group (group A) and selective lobar ventilation group (group B).In group A,an endobronchial blocker tube was used to obstruct the bronchus principalis and practice one-lung ventilation.In group B,an endobronchial blocker tube was used to obstruct the bronchi Iobares and practice selective lobar ventilation.Blood samples were taken from the arteria radialis and the internal jugular vein for blood gas analysis and determination of plasma concentrations of tumor necrosis factor-alpha (TNF-α),interleukin-6 (IL-6) and IL-8 by enzyme linked immunosorbent assay (ELISA) before anesthesia induction (T0),30 minutes following two-lung ventilation at the lateral position (T1),60 minutes following one-lung ventilation or selective lobar ventilation (T2) and at the end of surgery (T3).Peak airway pressure (Ppeak) and plateau airway pressure (Pplat) were recorded at the same time.Results The incidence of hypoxemia was significantly lower in group B (0) than in group A (18％,P ＜ 0.05).Compared with group A,Pliat and Ppeak at T1-3,the intrapulmonary shunt rate (Qs/Qt) at T2,TNF-α,IL-6 and IL-8 concentrations at T2-3 were significantly decreased in group B (P ＜ 0.05).Conclusion Selective lobar ventilation can reduce intrapulmonary shunt and inhibit inflammatory responses to help lessen mechanical ventilation-related lung injuryduring thoracotomy in patients with pulmonary dysfunction.
ABSTRACT
Objective To study T lymphocyte subsets levels in acute zoster patients and investigate its relation to the zoster associated pain.MethodsAccording to the visual analogue scales(VAS) in the acuter phase, 60 patients with herpes zoster were divided into two groups: group A (VAS≤6) and group B (VAS＞6). According to the follow-up results, patients were divided into another two groups: group C (PHN not developed) and group D (PHN developed). 25 healthy volunteers with a similar age and gender range as the patients were recruited as control group. T lymphocyte subsets were detected by fluorescence-activated cell sorter (FACS). ResultsThere was no significant difference in gender and age between groups (P＞0.05). T lymphocyte subsets were significantly decreased in four groups compared with the control group (P＜0.05), and the CD4 +subsets in group B were significantly decreased compared with group A (P＜0.05). The CD4 +/CD8 + ratios were significantly higher in group A and C than in control group, higher in group A than B and higher in group C than in group D (P＜0.05). The visual analogue scales(VAS) in group D were significantly higher than in group C (P＜ 0.05).Conclusions Cellular immunity function is decreased with the lower percent of the T lymphocytes subsets in the elderly patients with acute herpes zoster, especially in severe patients. The CD4 +/CD8 + ratios and the visual analogue scales may be associated with the the risk of post herpetic neuralgia.
ABSTRACT
ObjectiveTo investigate the effects of selective lobar ventilation on intrapulmonary shunt and inflammatory response in patients with pulmonary dysfunction during thoracotomy.MethodsThirty-four ASA Ⅱ or Ⅲ patients,aged 64-79 yr,weighing 50-85 kg,with moderate and severe impaired pulmonary function,scheduled for esophageal cancer radical correction,were randomly divided into 2 groups( n =17 each): one-lung ventilation group (group A) and selective lobar ventilation group (group B).In group A,endobronchial blocker tube was used to obstruct bronchus principalis and practice one-lung ventilation.In group B,endobronchial blocker tube was used to obstruct bronchi lobares and practice selective lobar ventilation.The blood samples were taken from arteria radialis and internal jugular vein for blood gas analysis and determination of the plasma concentrations of TNF-α,IL-6 and IL-8 by ELISA before anesthesia induction(T0 ),at 30 min following two-lung ventilation at lateral position (T1),at 60 min following one-lung ventilation or selective lobar ventilation (T2) and at the end of surgery (T3).Ppeak and Plat.were recordeded at the same time.ResultsThe incidence of hypoxemia was significantly lower in group B (0) than in group A(18％ )( P ＜0.05).Compared with group A,Pplat and Ppeak at T1-3,Qs/Qt at T2,TNF-α,IL-6 and IL-8 concentrations at T2-3 were significantly decreased in group B( P ＜ 0.05 ).Conclusion The selective lobar ventilation can reduce intrapulmonary shunt,inhibit inflammatory response to help lessen mechanical ventilation related lung injury during thoracotomy in patients with pulmonary function.