Non-invasive ventilation in the treatment of infants with respiratory failure after cardiopulmonary bypass / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate the effects of non-invasive ventilation in the treatment of infants with respiratory failure after cardiopulmonary bypass (CPB) and extubation.</p><p><b>METHOD</b>Sixty-three infants who had undergone successful surgery with CPB, got respiratory failure after extubation. These infants were randomly divided into two groups: non-invasive (NV) group, treated with non-invasive ventilation and invasive (IV) group, treated with tracheal intubation. The alteration of clinical symptoms, heart rate (HR), respiratory rate (RR), pulse oxygen saturation (SpO₂) and blood gas were measured. A comparison was conducted in the incidence of complication and hospital infection, mechanical ventilation time, length of stay in ICU and hospital stay.</p><p><b>RESULT</b>Among the 32 patients in NV group, 1 patient died of heart failure, the remaining 31 patients recovered. Of these 32, 26 patients had relief of respiratory failure, the HR 181 (19.7) bpm, RR 54 (16.7) bpm and PaCO₂ 55.5(6) mm Hg decreased to 157 (12) bpm, 35 (3.25) bpm, and 42 (10.5) mm Hg, meanwhile SpO₂ 87% (10.5%), pH 7.29 (0.24), PaO₂ 55.5(6) mm Hg increased to 96% (3%), 7.37(0.15), 82.5 (11) mm Hg after treatment with non-invasive ventilation (P < 0.01). Six patients underwent tracheal intubation because their condition was not improved. Tracheal hemorrhage or laryngeal edema did not occur in these patients. Among the 31 patients in IV group, 1 patient died of heart failure, the other patients were cured. Of these 30, one patient had tracheal hemorrhage and four patients had laryngeal edema. The incidence of hospital infection in NV group was lower compared with that in IV group. The mechanical ventilation time in NV group 42 (17.2) h was shorter compared with that in IV group 50 (20) h (P < 0.01). There was no significant difference in the length of ICU and hospital stay between the two groups.</p><p><b>CONCLUSION</b>Non-invasive ventilation is a safe and effective method to treat infants with respiratory failure after CPB and extubation.</p>

Individual immunosuppressive regime in heart transplantation with high risk / 中华外科杂志

<p><b>OBJECTIVE</b>To Summarize the clinical experience of individual immunosuppressive regime in heart transplantation with high risk.</p><p><b>METHODS</b>From September 2001 to December 2006, 51 cases with the complication of Hepatitis B viruses (HBV) infection, diabetes mellitus, renal dysfunction or pulmonary infection in perioperative period were analyzed retrospectively. All cases received daclizumab (Zenapax) induction therapy, and baseline triple immunosuppressive regime was consist of cyclosporine (CsA), azathioprine (Aza) or mycophenolate mofetil (MMF) and prednisone (Pred). Ten cases received HBV infection in preoperative period, the immunosuppressive protocol was emphasized on the use of MMF and the withdraw of Pred one month later in postoperation. Nine cases received diabetes mellitus in pre-operation, 4 cases had post-transplant diabetes mellitus. The immunosuppressive protocol was emphasized on the use of CsA rather than FK506, the use of Pred was less dosage, and the therapy of insulin was necessary. Sixteen cases had renal dysfunction in pre-operation, the use of MMF was routine but the use of CsA was delayed to the time 5 to 19 d postoperative. Twelve cases received pulmonary infection after allograft transplantation. The immunosuppressive agent was to be taped or suspended in therapy time.</p><p><b>RESULTS</b>The liver function of the 10 cases with HBV infection was stable in 1 year follow-up, and 1 case received acute rejection after 13 months allograft transplantation. In the 6 months follow-up, the blood glucose level of the 13 cases with diabetes mellitus was stable, none of the cases suffered from acute rejection. In the one month follow-up, none of the 16 cases with renal dysfunction suffered from acute rejection, and the renal function was normal. Two of the 12 cases with the pulmonary infection were died of serious infection, others were survival. One case received acute rejection on the 17th day in postoperation.</p><p><b>CONCLUSIONS</b>Low mortality can be realized by selecting appropriately individual immunosuppressive regime and the episode of acute rejection is rare.</p>

Early outcome of orthotopic heart transplantation: a report of 21 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To report the preliminary experience of 21 orthotopic heart transplantations without early death.</p><p><b>METHODS</b>Between April 2002 and June 2005, 21 patients underwent orthotopic heart transplantation. Recipients' pulmonary vascular resistance ranged from 3.0 to 5.9 wood units [mean (4.3 +/- 1.4) wood units]; Stanford myocardial protective solution or HTK solution was perfused for donor heart myocardial preservation, donor heart cold ischemic period ranged from 52 to 310 min [mean (81 +/- 23) min]; Three patients had previous cardiac operations under cardiopulmonary bypass, conventional Stanford orthotopic cardiac transplantation in 20 cases and total heart technique in 1 case; Recipients received simulect preoperatively and cyclosporine A, cellcept and prednisone postoperatively for prevention of acute allograft rejection; Patients received appropriate medical control of hypertension, hyperglycemia, hypercholesterolemia and uricacidemia.</p><p><b>RESULTS</b>Acute right heart failure in 3 cases and pericardial effusion in 4 cases were observed at the early postoperative stage, but no any infection and acute rejection were found. All patients survived with good life quality.</p><p><b>CONCLUSIONS</b>Heart transplantation may produce satisfying early results. Suitable selection of recipients with low pulmonary vascular resistance, excellent donor heart conservation, practised anastomotic technique, proper immunosuppression treatment and efficient postoperative management are key measures of orthotopic heart transplantation with excellent early outcome.</p>