Limb remote ischemic preconditioning attenuates biomarkers of acute lung injury and inflammation during thoracoscopic lobectomy: a randomized controlled trial

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Clinics Pub Date : 2026-01-01 Epub Date: 2026-02-17 DOI:10.1016/j.clinsp.2026.100883

Wenfu Zhang , Mingwang Zeng , Chao Yang , Lijun Yang , Juan Yang , Yi Wang , Haiyu Xie , Lifeng Wang , Maolin Zhong , Fuzhou Hua , Weidong Liang

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引用次数: 0

Abstract

Background

One-Lung Ventilation (OLV), though essential for thoracic surgery, triggers inflammation and oxidative stress that may lead to Acute Lung Injury (ALI). Remote Ischemic Preconditioning (RIPC) is a simple, non-invasive intervention that may activate protective pathways and reduce ischemia-reperfusion injury. This randomized controlled trial assessed whether limb RIPC attenuates OLV-induced lung injury during thoracoscopic lobectomy.

Methods

Fifty-four patients undergoing thoracoscopic lobectomy with OLV were randomized to the RIPC (n = 27) or Control (NC, n = 27) group. RIPC consisted of five cycles of 5-min ischemia and 5-min reperfusion using a lower limb tourniquet before OLV. Blood samples were collected at T0 (post-induction), T1 (30-min after OLV), T2 (90-min after OLV), and T3 (30-min after resumption two-lung ventilation). The primary endpoint was plasma CC16. Secondary endpoints included IL-6, MDA, arterial blood gases, Intraoperative Oxygenation Indices (OI, RI, A-aDO₂, a/A), and hospital stay.

Results

Plasma CC16, IL-6, and MDA levels were significantly lower in the RIPC group from T1 to T3 (all p < 0.001). In contrast, oxygenation indices, blood gas parameters, and hospital stay did not differ significantly between groups (all p > 0.05).

Conclusions

Limb RIPC effectively reduced systemic markers of lung injury (CC16), inflammation and oxidative stress during OLV but not in short-term improvements in oxygenation or clinical recovery. These findings suggest that RIPC confers molecular protection, with potential functional benefits requiring longer follow-up or evaluation in high-risk populations. Larger multicenter trials are warranted.

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肢体远端缺血预处理可减弱胸腔镜肺叶切除术期间急性肺损伤和炎症的生物标志物：一项随机对照试验。

背景：单肺通气（OLV）虽然在胸外科手术中必不可少，但会引发炎症和氧化应激，可能导致急性肺损伤（ALI）。远端缺血预处理（Remote Ischemic Preconditioning， RIPC）是一种简单、无创的干预手段，可激活保护性通路，减少缺血再灌注损伤。这项随机对照试验评估了胸腔镜肺叶切除术中肢体RIPC是否减轻olv诱导的肺损伤。方法：54例胸腔镜肺叶切除术合并OLV患者随机分为RIPC组（n = 27）和Control组（n = 27）。RIPC包括5个周期，在OLV前使用下肢止血带进行5分钟缺血和5分钟再灌注。在T0（诱导后）、T1 （OLV后30分钟）、T2 （OLV后90分钟）和T3（恢复双肺通气后30分钟）采集血样。主要终点是血浆CC16。次要终点包括IL-6、MDA、动脉血气、术中氧合指数（OI、RI、a - ado2、a/ a）和住院时间。结果：血浆CC16、IL-6、MDA水平在RIPC组T1 ~ T3显著降低（p < 0.001）。组间氧合指数、血气参数、住院时间差异无统计学意义（p < 0.05）。结论：肢体RIPC有效降低了OLV期间肺损伤（CC16）、炎症和氧化应激的全身标志物，但在氧合或临床恢复方面没有短期改善。这些发现表明RIPC具有分子保护作用，其潜在的功能益处需要在高危人群中进行更长时间的随访或评估。更大规模的多中心试验是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinics 医学-医学：内科

CiteScore

4.10

自引率

3.70%

发文量

129

审稿时长

52 days

期刊介绍： CLINICS is an electronic journal that publishes peer-reviewed articles in continuous flow, of interest to clinicians and researchers in the medical sciences. CLINICS complies with the policies of funding agencies which request or require deposition of the published articles that they fund into publicly available databases. CLINICS supports the position of the International Committee of Medical Journal Editors (ICMJE) on trial registration.