单肺通气对胸腹腔镜联合食管癌根治术患者肺内分流率和claudin-4蛋白的影响  

Effects of one-lung ventilation on pulmonary shunt rate and claudin-4 protein expression in patients undergoing thoracolaparoscopic radical esophagectomy

作　　者：张利[1] 高东艳[2] 刘伟[1] 陈慧清 ZHANG Li;GAO Dongyan;LIU Wei;CHEN Huiqing(Department of Anesthesiology,Second Affiliated Haspital,Faculty of Anesthesiology,Shanxi Medical University,Taiyuan 030001,China;Department of Anesthesiology,Second Affiliated Hospital of Shanxi Medical University)

机构地区：[1]山西医科大学麻醉学院附属第二医院麻醉教研室,太原030001 [2]山西医科大学第二医院麻醉科

出　　处：《山西医科大学学报》2020年第1期105-108,共4页Journal of Shanxi Medical University

摘　　要：目的 探讨食管癌手术行单肺通气过程中肺内分流率和claucdin-4蛋白的变化规律。方法 选取拟在全麻下行胸腹腔镜联合食管癌根治术的患者30例,抽取侧卧位单肺通气前10 min(T0)、单肺通气后60 min(T1)、恢复双肺通气后60 min(T2)时的桡动脉及中心静脉血,测定肺内分流率及血清中claudin-4蛋白,观察比较不同时段两组数值的变化规律及二者的相关性。结果 肺内分流率在不同时间点比较差异有统计学意义,T1时刻大于T0时刻和T2时刻(P<0.05),T0时刻与T2时刻比较差异无统计学意义(P>0.05);claudin-4在3个时间点的比较差异有统计学意义,T1、T2时刻大于T0时刻(P<0.05),T1时刻与T2时刻比较差异无统计学意义(P>0.05)。结论 单肺通气可以导致明显的肺内分流,且在恢复双肺通气后有改善,而claudin-4表达上调,起到一定的肺保护作用。Objective To investigate the changes of intrapulmonary shunt rate and claudin-4 protein during one-lung ventilation(OLV)for esophageal cancer surgery.Methods Thirty patients who planned to undergo thoracoscopic and laparoscopic esophagectomy for esophageal cancer were chosen.Blood samples from radial artery and internal jugular vein were collected 10 min(T 0)before OLV in lateral decubitus position(LDP),60 min(T 1)after OLV in LDP,60 min(T 2)after resumption of two-lung ventilation(TLV).Results Intrapulmonary shunt rate was significantly higher at T 1than at T 0(P<0.05)and T 2(P<0.05),and there was no significant difference between T 0 and T 2(P>0.05).Claudin-4 was higher at T 1,T 2than at T 0(P<0.05),but there was no significant diffe-rence between T 1 and T 2(P>0.05).Conclusion One-lung ventilation can lead to significant intrapulmonary shunt,and the intrapulmonary shunt can be improved after the recovery of two-lung ventilation,while the upregulation of claudin-4 may play a certain role in lung protection.

关 键 词：单肺通气 肺内分流率 紧密连接蛋白 CLAUDIN-4 

分 类 号：R614[医药卫生—麻醉学]