肺叶切除术患者单肺通气时肺组织水通道蛋白1和水通道蛋白4表达的变化  

Changes in expression of aquaporin 1 and aquaporin 4 in lung tissues during one-lung ventilation in patients undergoing pulmonary lobectomy

作　　者：李玮[1] 林飞[2] 潘灵辉[2] 黄冰[2] 梁锐[2] 魏玥[1] 

机构地区：[1]广西医科大学研究生院,南宁市530021 [2]广西医科大学附属肿瘤医院麻醉科

出　　处：《中华麻醉学杂志》2013年第8期955-958,共4页Chinese Journal of Anesthesiology

基　　金：2010广西科技厅青年基金资助项目（01308）

摘　　要：目的 评价肺叶切除术患者单肺通气时肺组织水通道蛋白1（AQP1）和水通道蛋白4（AQP4）表达的变化.方法 择期拟行肺叶切除术患者40例,ASA分级Ⅰ级或Ⅱ级,年龄30 ～ 64岁,体重45 ～ 79kg,采用随机数字表法,将其分为2组（n=20）：双肺通气组（T组）和单肺通气组（O组）.静脉注射咪达唑仑、芬太尼、维库溴铵和丙泊酚麻醉诱导,T组插入气管导管行双肺通气；O组插入双腔支气管导管行双肺通气,开胸后行单肺通气,维持PETCO25.3 ～ 24.0 kPa,SpO2＞92％.静脉输注瑞芬太尼、丙泊酚和维库溴铵维持麻醉.取病变旁正常肺组织,光镜下观察病理学结果,透射电镜下观察超微结构改变；测定肺组织湿干重比（W/D比）；采用RT-PCR法检测肺组织AQP1 mRNA和AQP4mRNA的表达,采用法检测肺组织AQP1蛋白和AQP4蛋白的表达.结果 与T组比较,O组肺组织W/D比升高,AQP1 mRNA及其蛋白表达下调（P＜0.05）,AQP4 mRNA及其蛋白表达差异无统计学意义（P＞0.05）,肺组织出现病理学损伤.结论 AQP1表达下调可能参与了单肺通气诱发的肺叶切除术患者急性肺损伤,而AQP4无此作用.Objective To evaluate the changes in the expression of aquaporin 1 （AQP1） and aquaporin4 （AQP4） in lung tissues during one-lung ventilation in patients undergoing pulmonary lobectomy.Methods Forty ASA physical status Ⅰ or Ⅱ patients,aged 30-64 yr,weighing 45-79kg,undergoing pulmonary lobectomy,were randomly divided into 2 groups（n=20 each）：two-lung ventilation group （group T） and one-lung ventilation group （group O）.Anesthesia was induced with iv injection of midazolam,fentanyl,vecuronium and propofol.In group T,the patients were intubated with a single-lumen endotracheal tube and two-lung ventilation was performed.In group O,double-lumen endobranchial tube was inserted,and two-lung ventilation was performed followed by onelung ventilation after chest opening.PET CO2 was maintained at 5.3-24.0 kPa and SpO2 was maintained ＞ 92％.Anesthesia was maintained with iv infusion of remifentanil,propofol and vecuronium.The normal lung tissues were obtained from the site near the pathologic changes for microscopic examination （with light microscope） and examination of the ultrastructure （with transmission electron microscope）,and for determination of W/D lung weight ratio,the expression of AQP1 mRNA and AQP4 mRNA （by RT-PCR） and the expression of AQP1 protein and AQP4 protein （by Western blot）.Results Compared with group T,W/D lung weight ratio was significantly increased,the expression of AQP1 mRNA and protein was down-regulated in group O （P ＜ 0.05）,and no significant changes were found in the expression of AQP4 mRNA and protein in group O （P ＞ 0.05）.Pathological changes were observed in group O.Conclusion Down-regulation of AQP1 expression may be involved in the acute lung injury induced by one-lung ventilation in patients undergoing pulmonary lobectomy,however,AQP4 has no such effect.

关 键 词：水通道蛋白质1 水通道蛋白质4 呼吸 人工 

分 类 号：R614[医药卫生—麻醉学]