術前肺保護對肺組織肺表面活性蛋白A及術后并發(fā)癥的影響
發(fā)布時間：2018-08-22 09:28
【摘要】：目的肺表面活性蛋白A(SP-A)是肺組織中表達最豐富、信號最強烈的肺表面活性物質相關蛋白(約占50%),主要由II型肺泡上皮細胞和氣道clara細胞合成和分泌,有維持肺泡穩(wěn)定性、抗炎殺菌以及調節(jié)免疫等功能。在正常條件下,SP-A可以避免煙霧、粉塵、油煙、微生物等各種危險因素引起的肺損傷和肺感染,保護肺組織的作用。肺組織中SP-A表達越多,維持肺內穩(wěn)態(tài)和抵御炎性損傷的能力越強。促進SP-A的表達合成,對保護肺組織有重要意義。作為呼吸科常用藥的氨溴索和布地奈德能提高內源性SP-A表達。術前肺保護藥物治療可以有效改善肺功能,肺功能與肺組織中SP-A表達水平有一定相關性。本研究探討術前肺保護治療對非小細胞肺癌(NSCLC)合并慢性阻塞性肺疾病(COPD)患者肺組織中SP-A表達及術后并發(fā)癥的影響。方法入組2015年1月至2016年6月就診于天津市胸科醫(yī)院胸外科行手術治療的非小細胞肺癌合并慢性阻塞性肺疾病患者60例,對照組和肺保護組各30例,對照組予以常規(guī)術前準備后行手術治療,肺保護組在常規(guī)術前準備的基礎上給予1周術前肺保護治療后再行手術治療,肺保護治療藥物包括氨溴索、多索茶堿、布的奈德、異丙托溴銨等,用便攜式呼出冷凝液收集裝置收集入院及術前呼出氣冷凝液(EBC)并復查肺功能,酶聯(lián)免疫吸附測定(ELISA)法檢測EBC中SP-A的含量。術中快速收集肺組織標本,距病灶5cm以上取大小約1cm3肺組織2塊,免疫印跡法(Western blotting)測定肺組織SP-A水平。術后予以相關康復治療,如有并發(fā)癥及時處理,并記錄患者并發(fā)癥的情況,按照Clavien-Dindo分級系統(tǒng)進行術后并發(fā)癥分析。比較兩組之間肺組織SP-A表達水平及術后并發(fā)癥情況。結果1.肺保護組中肺組織SP-A水平高于對照組(1.05±0.21 vs 0.93±0.16),差異有統(tǒng)計學意義(P0.05)。2.肺保護組術前EBC中SP-A含量較入院時提高[(5.51±1.48)ng/L vs(4.99±1.32)ng/L],差異有統(tǒng)計學意義(P0.01)。術前EBC中SP-A含量與肺組織中SP-A水平呈正相關(r=0.460,P0.01)。3.經(jīng)肺保護治療后,術前肺功能指標FEV1、FEV1%、FEV1/FVC、FVC、FVC%較入院時提高,差異有統(tǒng)計學意義(P0.01)。且入院EBC中SP-A含量同入院肺功能中的FEV1%呈正相關(r=0.343,P=0.007)。4.兩組患者術后并發(fā)癥、Clavien-Dindo并發(fā)癥分級差異無統(tǒng)計學意義(P0.05),兩組患者手術時長、術中出血量、術后帶管時長差異無統(tǒng)計學意義(P0.05),肺保護組術后平均住院日少于對照組[(9.2±3.1)d vs(11.6±4.8)d],差異有統(tǒng)計學意義(P0.05)。結論1.術前肺保護能提高肺組織中SP-A表達含量。2.經(jīng)過術前肺保護治療,術前EBC中SP-A含量較入院時提高,與肺組織中SP-A變化趨勢一致。3.術前肺保護能夠改善肺功能和縮短術后住院時間。4.術前肺保護在術后并發(fā)癥及Clavien-Dindo并發(fā)癥分級系統(tǒng)并未體現(xiàn)出統(tǒng)計學優(yōu)勢。
[Abstract]:Objective Pulmonary surfactant protein A (SP-A) is the most highly expressed and strongly expressed surfactant associated protein (50%) in lung tissues. It is mainly synthesized and secreted by type II alveolar epithelial cells and airway clara cells. Anti-inflammatory sterilization and regulation of immune function. Under normal conditions, SP-A can avoid lung injury and infection caused by smoke, dust, oil fume and microorganism, and protect lung tissue. The higher the expression of SP-A in lung tissue, the stronger the ability of maintaining stable state and resisting inflammatory injury. Promoting the expression and synthesis of SP-A plays an important role in protecting lung tissue. Ambroxol and budesonide, which are commonly used in respiratory department, can increase endogenous SP-A expression. Preoperative lung protection therapy can effectively improve lung function, and lung function is correlated with the expression of SP-A in lung tissue. This study was to investigate the effect of preoperative lung protection therapy on the expression of SP-A and postoperative complications in patients with (NSCLC) complicated with chronic obstructive pulmonary disease (COPD) in non-small cell lung cancer (NSCLC). Methods from January 2015 to June 2016, 60 patients with non-small cell lung cancer (NSCLC) complicated with chronic obstructive pulmonary disease (COPD), 30 patients in control group and 30 patients in lung protection group were treated by thoracic surgery in Tianjin chest Hospital. The control group was treated with routine preoperative preparation, the lung protection group was treated with preoperative lung protection therapy after 1 week of preoperative lung protection therapy, and the lung protection drugs included ambroxol, doxofylline and bupropion. Ipratropium bromide was used to collect (EBC) from admission and preoperative exhalation condensate with portable exhalation condensate collection device and to examine the pulmonary function. The content of SP-A in EBC was detected by (ELISA) method. The lung tissue samples were collected quickly during the operation. The size of 1cm3 lung tissue was about 2 from the lesion 5cm. The SP-A level of lung tissue was measured by Western blot (Western blotting). The postoperative complications were analyzed according to the Clavien-Dindo grading system. The expression of SP-A and postoperative complications were compared between the two groups. Result 1. The level of SP-A in lung protection group was significantly higher than that in control group (1.05 鹵0.21 vs 0.93 鹵0.16) (P0.05). In the lung protection group, the level of SP-A in preoperative EBC was significantly higher than that at admission [(5.51 鹵1.48) ng/L vs (4.99 鹵1.32) ng/L] (P0.01). There was a positive correlation between the content of SP-A in EBC and the level of SP-A in lung tissue before operation (r = 0.460, P 0.01). After lung protection treatment, the preoperative FEV1 / FEV1 / FEV1 / FVC+ FVCU FVC% was significantly higher than that on admission (P0.01). There was a positive correlation between the content of SP-A in EBC and FEV1% in pulmonary function (r = 0.343P0. 007) .4. There was no significant difference in the classification of postoperative complications between the two groups (P0.05). There was no significant difference in the length of the tube after operation (P0.05), and the average length of hospitalization in the lung protection group was less than that in the control group [(9.2 鹵3.1) d vs (11.6 鹵4.8) days], and the difference was statistically significant (P0.05). Conclusion 1. Preoperative lung protection can increase the expression of SP-A in lung tissue. 2. 2. After preoperative lung protection therapy, the content of SP-A in preoperative EBC was higher than that in admission, which was consistent with the trend of SP-A in lung tissue. 3. Preoperative lung protection can improve lung function and shorten postoperative hospitalization time. 4. 4. Preoperative lung protection did not show statistical advantage in postoperative complications and Clavien-Dindo complication classification system.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R734.2;R563.9
本文編號：2196693
[Abstract]:Objective Pulmonary surfactant protein A (SP-A) is the most highly expressed and strongly expressed surfactant associated protein (50%) in lung tissues. It is mainly synthesized and secreted by type II alveolar epithelial cells and airway clara cells. Anti-inflammatory sterilization and regulation of immune function. Under normal conditions, SP-A can avoid lung injury and infection caused by smoke, dust, oil fume and microorganism, and protect lung tissue. The higher the expression of SP-A in lung tissue, the stronger the ability of maintaining stable state and resisting inflammatory injury. Promoting the expression and synthesis of SP-A plays an important role in protecting lung tissue. Ambroxol and budesonide, which are commonly used in respiratory department, can increase endogenous SP-A expression. Preoperative lung protection therapy can effectively improve lung function, and lung function is correlated with the expression of SP-A in lung tissue. This study was to investigate the effect of preoperative lung protection therapy on the expression of SP-A and postoperative complications in patients with (NSCLC) complicated with chronic obstructive pulmonary disease (COPD) in non-small cell lung cancer (NSCLC). Methods from January 2015 to June 2016, 60 patients with non-small cell lung cancer (NSCLC) complicated with chronic obstructive pulmonary disease (COPD), 30 patients in control group and 30 patients in lung protection group were treated by thoracic surgery in Tianjin chest Hospital. The control group was treated with routine preoperative preparation, the lung protection group was treated with preoperative lung protection therapy after 1 week of preoperative lung protection therapy, and the lung protection drugs included ambroxol, doxofylline and bupropion. Ipratropium bromide was used to collect (EBC) from admission and preoperative exhalation condensate with portable exhalation condensate collection device and to examine the pulmonary function. The content of SP-A in EBC was detected by (ELISA) method. The lung tissue samples were collected quickly during the operation. The size of 1cm3 lung tissue was about 2 from the lesion 5cm. The SP-A level of lung tissue was measured by Western blot (Western blotting). The postoperative complications were analyzed according to the Clavien-Dindo grading system. The expression of SP-A and postoperative complications were compared between the two groups. Result 1. The level of SP-A in lung protection group was significantly higher than that in control group (1.05 鹵0.21 vs 0.93 鹵0.16) (P0.05). In the lung protection group, the level of SP-A in preoperative EBC was significantly higher than that at admission [(5.51 鹵1.48) ng/L vs (4.99 鹵1.32) ng/L] (P0.01). There was a positive correlation between the content of SP-A in EBC and the level of SP-A in lung tissue before operation (r = 0.460, P 0.01). After lung protection treatment, the preoperative FEV1 / FEV1 / FEV1 / FVC+ FVCU FVC% was significantly higher than that on admission (P0.01). There was a positive correlation between the content of SP-A in EBC and FEV1% in pulmonary function (r = 0.343P0. 007) .4. There was no significant difference in the classification of postoperative complications between the two groups (P0.05). There was no significant difference in the length of the tube after operation (P0.05), and the average length of hospitalization in the lung protection group was less than that in the control group [(9.2 鹵3.1) d vs (11.6 鹵4.8) days], and the difference was statistically significant (P0.05). Conclusion 1. Preoperative lung protection can increase the expression of SP-A in lung tissue. 2. 2. After preoperative lung protection therapy, the content of SP-A in preoperative EBC was higher than that in admission, which was consistent with the trend of SP-A in lung tissue. 3. Preoperative lung protection can improve lung function and shorten postoperative hospitalization time. 4. 4. Preoperative lung protection did not show statistical advantage in postoperative complications and Clavien-Dindo complication classification system.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R734.2;R563.9
【參考文獻】
相關期刊論文 前10條
1 賴玉田;蘇建華;楊梅;周坤;車國衛(wèi);;術前短期綜合肺康復訓練對肺癌合并輕中度慢性阻塞性肺病患者的影響:一項前瞻性隨機對照試驗[J];中國肺癌雜志;2016年11期
2 支修益;何建行;劉倫旭;姜格寧;車國衛(wèi);邱源;吳齊飛;劉錦銘;;多學科圍手術期氣道管理專家共識(2016年版)[J];中國胸心血管外科臨床雜志;2016年07期
3 王妍亭;顏浩;韓娟;劉進衡;;肺表面活性蛋白A與肺部疾病關系的研究進展[J];實用心腦肺血管病雜志;2016年06期
4 劉玉;張梅;袁耒;胡鳳標;鄒志強;;伴中、重度慢性阻塞性肺疾病行開胸手術患者圍手術期氣道管理藥物應用評價[J];中國胸心血管外科臨床雜志;2015年12期
5 韓麗萍;朱君;賈建軍;付甜;苗健龍;;慢性阻塞性肺疾病患者血清SP-A水平及臨床意義的探討[J];國際呼吸雜志;2015年09期
6 車國衛(wèi);支修益;;肺癌合并慢性阻塞性肺疾病患者圍手術期氣道管理現(xiàn)狀[J];中國肺癌雜志;2014年12期
7 支修益;;加強胸外科圍手術期氣道管理,降低肺癌合并慢性阻塞性肺病患者并發(fā)癥[J];中國胸心血管外科臨床雜志;2014年05期
8 蘇建華;喻鵬銘;周渝斌;蒲強;何成奇;劉倫旭;車國衛(wèi);;影響肺癌手術住院費用和快速康復的臨床因素分析[J];中國肺癌雜志;2014年07期
9 賈俊青;賈俊亞;;表面活性蛋白A、D在慢性阻塞性肺疾病的診斷及治療中的意義[J];中華臨床醫(yī)師雜志(電子版);2012年23期
10 李冬艷;張新日;劉超峰;;機械通氣對大鼠肺組織SP-A表達的影響及氨溴索的干預作用研究[J];中華肺部疾病雜志(電子版);2012年05期
相關博士學位論文 前1條
1 董碩;不同劑量鹽酸氨溴索對開胸手術圍術期肺保護作用的研究[D];中南大學;2012年
相關碩士學位論文 前3條
1 楊天池;Clavien-Dindo分級在分析肝功能衰竭肝移植術后并發(fā)癥相關因素中的應用[D];首都醫(yī)科大學;2016年
2 涂瀾濤;宮頸癌手術的病例分析及相關并發(fā)癥的研究[D];南昌大學醫(yī)學院;2015年
3 何蓉;高氧肺損傷新生大鼠肺組織中肺表面活性物質相關蛋白-A（SP-A）的mRNA和蛋白表達及布地奈德的干預作用[D];蘇州大學;2013年
，本文編號：2196693
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