不同通气方式对肺叶切除术患者S100A8蛋白表达的影响

目的 探讨血清钙结合蛋白Calgranulin A（S100A8）在不同通气方式下行肺叶切除术的表达。方法 选择行肺叶切除术肺癌患者20例，根据采用不同通气方式，分为单肺通气组和双肺通气组，每组10例。记录两组患者的手术时间、麻醉时间、总输液量、氧合指数、苏醒时间、拔管时间、吸痰次数、有无肺炎、有无肺不张、术后住院时间、有无死亡等情况。采用Western blot分别在手术前（T0）、手术结束时（T1）、术后24 h（T2）和术后48 h（T3）检测两组患者血清中S100A8的表达。结果 单肺通气组和双肺通气组患者手术时间、麻醉时间、总输液量、苏醒时间、拔管时间、吸痰次数、肺炎发生情况、肺不张发生情况、死亡发生情况等比较差异均无统计学意义（P＞0.05）。单肺通气组氧合指数较双肺通气组低［（296.20±77.64） mmHg vs （319.20±30.23） mmHg，t=2.189，P=0.042）］，术后住院时间增加［（7.80±1.87） d vs  （6.20±1.48） d，t=2.121，P=0.048］。术前单肺通气组和双肺通气组S100A8表达量差异无统计学意义（P＞0.05）。重复方差分析显示，不同通气方式S100A8表达组间差异有统计学意义（F=310.76，P＜0.001），随时间变化的趋势不同（F=24.85，P=0.025），组间与时间点存在交互作用（F=18.85， P=0.001）。结论 行开胸肺叶切除术肺癌患者采用单肺通气较双肺通气的术中氧合指数降低，且S100A8表达升高，可能与其更易发生呼吸机相关性肺损伤有关。

Effect of different ventilation modes on the expression of S100A8 protein in patients undergoing pulmonary lobectomy

Objective To investigate the expression of Calgranulin A（S100A8） in serum during lobectomy under different ventilation modes. Methods Twenty patients with lung cancer who underwent pulmonary lobectomy were divided into one-lung ventilation group and two-lung ventilation group according to different ventilation modes，with 10 cases in each group. The operation time，anesthe-sia time，total infusion volume，oxygenation index，recovery time，extubation time，sputum suction times，pneumonia，atelectasis，hospi-tal stay and death were recorded. Western blot was used to detect the expression of S100A8 in the patients serum in the two groups before operation （T0），at the end of operation （T1），24 hours after operation （T2） and 48 hours after operation （T3）. Results There were no significant differences in operation time，anesthesia time，total infusion volume，recovery time，extubation time，sputum suction times，pneumonia cases，atelectasis cases and death cases between the two groups（P>0.05）. The oxygenation index in one-lung ventilation group was significantly lower than that in two-lung ventilation group ［（296.20±77.64） mmHg vs  （319.20±30.23） mmHg，t=2.189，P=0.042］，and the hospital stay increased significantly ［（7.80±1.87） d vs （6.20±1.48） d，t=2.121，P=0.048］. There was no significant difference in the expression of S100A8 between one-lung ventilation group and two-lung ventilation group before operation（P>0.05）. Repeated variance analysis showed that there was significant difference among the groups with different ventilation modes（F=310.76，P<0.001）. The trend of change over time was different（F=24.85，P=0.025）. There was interaction between the time and time point（F=18.85，P=0.001）. Conclusions The intraoperative oxygenation index of lung cancer patients undergoing thoracotomy with one-lung ventilation is lower than that with two-lung ventilation，and the expression of S100A8 is higher，which may be related to the higher incidence of ventilator-associated lung injury.