探讨中度高海拔地区开胸手术对肺泡表面活性物质(PS)的影响。

收集2013年9月至2015年4月在青海省人民医院胸外科经左胸行食管癌根治术胸内吻合术患者21例，分别于手术前后行左、右肺支气管肺泡灌洗，测定支气管肺泡灌洗液(BALF)中PS的活性水平，包括饱和卵磷脂(SatPC)、总磷脂(TCP)、总蛋白(TP)。以右侧肺为对照组，并以饱和卵磷脂/总磷脂(SatPC/TPL)比值和饱和卵磷脂/总蛋白(SatPC/TP)比值作为判断PS活性的指标。

术前左、右侧肺BALF中的SatPC/TPL分别为(48.75±14.39)%和(48.76±12.90)%，SatPC/TP分别为(10.88±2.24)%和(11.78±2.24)%，差异均无统计学意义(t＝－0.0024，P>0.05；t＝－1.3019，P>0.05)。术后左侧肺的SatPC/TPL为(26.15±9.81)%，明显低于右侧的(47.62±12.58)%；术后左侧肺的SatPC/TP为(5.34±2.54)%，也显著低于右侧的(10.15±2.28)%，差异均有统计学意义(t＝6.1674，P<0.01；t＝6.4579，P<0.01)。左侧肺术后与术前BALF中的SatPC/TPL分别为(26.15±9.81)%和(48.75±14.39)%)，SatPC/TP分别为(5.34±2.54)%和(10.88±2.24)%，差异均有统计学意义(t＝5.9467，P<0.01；t＝7.4964，P<0.01)。右侧肺术后与术前BALF中的SatPC/TPL分别为(47.62±12.58)%和(48.76±12.90)%, SatPC/TP分别为(10.15±2.28)%和(11.78±2.24)%，差异均无统计学意义(t＝0.2889，P>0.05；t＝2.3370，P>0.05)。

在中度高海拔地区开胸手术对于患者术侧肺功能造成一定损伤，使PS活性明显下降；对非术侧肺功能不造成损伤，对PS活性无明显影响。

To investigate the effect of thoracotomy on pulmonary surfactant(PS) in moderate high altitude localities.

Twenty-one patients with esophageal carcinoma undergoing thoracotomy on the left between September 2013 and April 2015 in Department of Thoracic Surgery in Qinhai Provincial People’s Hospital were enrolled. Bilateral broneho-alveolar lavage was carried out before and after operation. The indicators including saturated phosphati-dylcholine (SatPC), total protein(TP) and total phospholipid(TPL) in broneho-alveolar lavage fluid (BALF) were measured. The corresponding indicators in the right side were served as controls, and SatPC/TPL and SatPC/TP as indicators of activity of PS in BALF.

Before operation, the values of SatPC/TPL in BALF were (48.75±14.39)% and (48.76±12.90)% in the left side and right side, respectively, and those were (10.88±2.24)% and (11.78±2.24)%, respectively for SatPC/TP in BALF, with no significant difference in these two indicators between two sides(t=-0.0024, P>0.05; t=-1.3019, P>0.05). After operation, the value of SatPC/TPL in BALF in the left side was significantly smaller than that in the right side [(26.15±9.81)% vs (47.62±12.58)%, t=6.1674, P<0.01], and the value of SatPC/TP in BALF in the left side was also significantly smaller than that in the right side [(5.34±2.54)% vs (10.15±2.28)%, t=6.4579, P<0.01]. The value of SatPC/TPL in BALF after operation was significantly smaller than that before operation in the left side[ (26.15±9.81)% vs (48.75±14.39)%, t=5.9467, P<0.01], and the value of SatPC/TP in BALF after operation was also significantly smaller than that before operation in the left side[ (5.34±2.54)% vs (10.88±2.24)%, t=7.4964, P<0.01]. The value of SatPC/TPL in BALF after operation was not significantly different from that before operation in the right side[ (47.62±12.58)% vs (48.76±12.90)%, t=0.2889, P>0.05], and the value of SatPC/TP in BALF after operation was also not significantly smaller than that before operation in right left side [ (10.15±2.28)% vs (11.78±2.24)%, t=2.3370, P>0.05].

In the moderate high altitude localities, thoracotomy may induce lung injury and decrease the activity of PS in the operation side, while it may not cause injury in the non-operation side.