Experience of perioperative treatment of lung transplantation: report of 7 cases / 器官移植

Objective To summarize the experience of perioperative treatment of lung transplantation for end-stage lung disease. Methods Perioperative clinical data of 7 recipients undergoing lung transplantation were retrospectively analyzed, including 3 cases with bilateral lung transplantation and 4 cases with unilateral lung transplantation. The perioperative status and clinical prognosis of lung transplantation recipients were observed. Results The operation time of 7 lung transplantation recipients was (344±133) min. Cold ischemia time was (236±74) min in 4 cases of single-lung transplantation and (480±120) min in 3 cases of bilateral-lung transplantation. The length of Intensive care unit(ICU) stay was 21 (13-25) d and the length of hospital stay was 101 (64-117) d. In the first 3 d after surgery, the daily fluid output was significantly larger than the fluid input (all P < 0.05). The arterial oxygen partial pressure (PaO2) of lung transplantation recipients in the first 3 d after surgery was significantly elevated than preoperative level (all P < 0.05), whereas the arterial carbon dioxide pressure (PaCO2) did not significantly change (all P > 0.05). All recipients had pulmonary bacterial infection after lung transplantation, including 3 cases complicated with fungal infection. One recipient underwent exploratory thoracotomy for hemostasis due to active thoracic bleeding after operation, 1 recipient suffered from primary graft dysfunction (PGD) and 4 recipients received secondary endotracheal intubation. Two cases died after operation, 1 case died of septicemia caused by multidrug-resistant acinetobacter baumannii, the other case died of rejection reaction after self-terminating use of immunosuppressive agents. The remaining 5 cases were successfully discharged and recovered well. The longest survival period was 3.1 years. Conclusions In the perioperative management of lung transplantation, it has great significance to hold the surgical indications, monitor and manage postoperative refined fluid and hemodynamics, implement the strategy of protective pulmonary ventilation, and early diagnose and treat severe postoperative complications for the recipients of lung transplantation to safety through the perioperative period.

Influence of N-acetylcysteine on FEV1, VC, DLCO, PaO2 in patients with chronic obstructive pulmonary disease and pulmonary interstitial fibrosis / 中国基层医药

Objective@#To investigate the influence of N-acetylcysteine on forced expiratory volume in one second(FEV1), vital capacity(VC), diffusion capacity of lung carbon monoxide(DLCO), arterial oxygen partial pressure(PaO2) in patients with chronic obstructive pulmonary disease(COPD) and pulmonary interstitial fibrosis.@*Methods@#From January 2015 to July 2017, 140 COPD patients complicated with pulmonary interstitial fibrosis in the People's Hospital of Shanxi Province were chosen as study objects, and they were divided into control group and research group according to the digital table, with 70 cases in each group.The control group was treated with routine treatment, while the research group was treated with N-acetylcysteine.After treatment, the treatment effects, VC, FEV1, PaO2, DLCO, TGF-β and VEGF between the two groups were compared.@*Results@#The total effective rate of the research group was 82.86%(58/70), which of the control group was 58.57%(41/70), the difference was statistically significant (χ2=9.968, P<0.05). Before treatment, the pulmonary function between the two groups had no statistically significant difference(t=0.082, 0.028, 0.421, 0.155, all P>0.05). After treatment, the FEV1[(59.03±15.02)% vs.(53.35±13.71)%], VC[(69.95±11.83)% vs.(65.21±11.65)%], DLCO[(68.92±11.56)% vs.(64.01±11.34)%] and PaO2[(68.79±5.38)mmHg vs.(62.37±6.14)mmHg]of the research group were higher than those of the control group, the differences were statistically significant (t=2.337, 2.389, 2.537, 6.580, all P<0.05). Before treatment, the TGF-β and VEGF levels between the two groups had no statistically significant differences(t=1.230, 0.016, all P>0.05). After treatment, the VEGF[(0.32±0.04)ng/L vs.(0.44±0.05)ng/L] and TGF-β[(271.16±35.21)ng/L vs.(345.13±39.08)ng/L] levels of the research group were lower than those of the control group, the differences were statistically significant (t=11.765, 15.680, all P<0.05). There was no statistically significant difference in the incidence rate of adverse reactions between the two groups(1.43% vs 4.28%, χ2=2.323, P>0.05).@*Conclusion@#Large dose of N-acetylcysteine can effectively improve the TGF-β and VEGF levels of COPD patients complicated with pulmonary interstitial fibrosis, and promote its pulmonary function, with good safety.

Therapeutic effect of nicorandil for treatment of patients with acute respiratory distress syndrome / 中国中西医结合急救杂志

Objective To investigate the clinical effect of nicorandil for treatment of patients with acute respiratory distress syndrome (ARDS).Methods A prospective randomized controlled trial was conducted. A total of 40 cases of patients with ARDS admitted to Department of Critical Care Medicine of Guizhou Provincial People's Hospital from October 2012 to October 2014 were enrolled, and they were randomly divided into two groups, 20 cases in each group. The two groups were treated with routine western medicine after admission. On this basis, the observation group was given nicorandil 10 mg, while the control group was given warm boiled water 10 mL, through gastric tubes 3 times a day, the therapeutic course being consecutive 5 days in both groups. The length of stay in intensive care unit (ICU), duration of mechanical ventilation after treatment, oxygenation index (OI), alveolo-arterial oxygen partial pressure difference (PA-aO2), positive end-expiratory pressure (PEEP), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, Glasgow coma score (GCS) before and after treatment, the predicted death rate (PDR) and 28-day mortality were compared between the two groups. The predicitive factors for 28-day mortality were screened by binary logistic analysis.Results The length of stay in ICU and duration of mechanical ventilation of control group were longer than those of observation group, but the difference was not statistically significant [ICU length of stay (day): 14.55±12.71 vs. 9.15±6.00, duration of mechanical ventilation (day): 13.25±12.27 vs. 7.75±5.32, bothP > 0.05]. After treatment, the GCS was higher than that before treatment in control group and observation group (11.95±3.98 vs. 10.75±4.89, 12.95±3.67 vs. 12.20±4.56), while APACHE Ⅱ score, PDR and PEEP were all lower than those before treatment [APACHE Ⅱ: 21.05±8.58 vs. 24.90±5.63, 18.70±11.21 vs. 26.65±7.67; PDR: (47.71±29.49)% vs. (61.00±23.29)%, (36.79±18.49)% vs. (56.12±18.16)%; PEEP (cmH2O, 1 cmH2O = 0.098 kPa): 4.40±3.14 vs. 5.75±2.59, 3.80±2.55 vs. 7.55±3.32], but there were no statistically significant differences between the two groups before and after treatment (allP > 0.05). After treatment, the OI was significantly higher and the PA-aO2 was significantly lower than those before treatment in the two groups, and the degrees of improvement of the observation group were more remarkable than those of the control group [OI (mmHg, 1 mmHg = 0.133 kPa): 224.72±85.12 vs. 141.37±45.82, PA-aO2 (mmHg): 132.60±46.64 vs. 204.30±121.2, bothP 0.05). Binary logistic regression analyses showed that the PA-aO2 [odds ratio (OR) = 0.958,P = 0.013, 95% confidence interval (95%CI) = 0.927 - 0.991], APACHE Ⅱ score (OR = 0.882,P = 0.010, 95CI = 0.803 - 0.970), GCS (OR = 1.399, P = 0.004, 95%CI = 1.111 - 1.761) and PDR (OR = 0.907,P = 0.002, 95%CI = 0.853 - 0.965) after treatment were the independent predictors of 28-day mortality.Conclusion Nicorandil can significantly improve oxygenation, but cannot reduce 28-day mortality in patients with ARDS.

The Effect of Positioning with Mechanically Ventilatory Acute Respitatory Failure Patients on Arterial Oxygen Partial Pressure and Alveolar-arterial Oxygen tension / 성인간호학회지

It is widely recognized that manipulation of body position takes advantage of the influences of gravity for improving oxygenation. The study aims to determine the effects of positioning(supine, prone, right lateral decubitus and left lateral decubitus positions) applied to the mechanically ventilatory acute respiratory failure patients on arterial oxygen partial pressure(PaO2), alveolar arterial oxygen tension difference(AaDO2), mean aterial pressure, peak inspiratory pressure and plateau pressure. Thirty two acute respiratory failure patients admitted to the medical intensive care unit at Kangnam St. Mary's Hospital, The Catholic University of Korea from March 1997 to January 1998, were divided into three groups by radiographic evidence of unilateral or bilateral lung disease. In group 1 with dominant right lung disease were twelve subjects, group 2 with dominant left lung disease had eight subjects and group 3 had twelve subjects with bilateral lung disease. The variables were measured in 30 minutes after each position of supine, prone, good lung down lateral decubitus and sick lung down lateral decubitus position. The position order was done at random by Latin squre design. The results are as follows; 1) With group 1 patients, the PaO2 in the left lateral decubitus and prone position were 126.8+/-30.8 mmHg and 106.7+/-36.8 mmHg, respectively(p=0.0001). 2) With group 2 patients, the PaO2 in the prone and the right lateral decubitus position were 121.7+/-44.7 mmHg and 118.5+/-31.7 mmHg, respectively (p=0.0018). 3) With group 3 patients, the PaO2 was 143.6+/-36.6 mmHg in the prone position (p=0.0001). 4) With group 1 patients, the AaDO2 in the left lateral decubitus and the right lateral decubitus position were 178.1+/-29.7 mmHg and 233.1+/-24.4 mmHg, respectively(p=0.0001). 5) With group 2 patients, the AaDO2 in the prone and the left lateral decubitus postion were 184.0+/-39.5 mmHg and 231.0+/-23.9 mmHg, respectively(p=0.0019). 6) With group 3 patients, the AaDO2 in the prone and the supine postion were 377.1+/-35.6 mmHg and 435.7+/-13.1 mmHg, respectively (p=0.0001). 7) There were no differences among the mean arterial pressure, peak inspiratory pressure and plateau pressure for each of the supine, prone, left lateral decubitus and right lateral decubitus position. The results suggest that oxygenation may improve in mechanically ventilatory patients with unilateral lung disease when the position is good lung dependent and prone, and patients with bilateral lung disease when the position is prone without any effects on the mean arterial pressure and airway pressure. It is suggested that body positions improve ventilation/perfusion matching and oxygenation need to be specified in patient care plans.

Effects of Isoflurane on Hypoxic Pulmonary Vasocontriction in Human during One Lung Ventilation / 대한마취과학회지

BACKGROUND: During one lung ventilation(OLV), the nonventilated lung profounds ventilation/ perfusion mismatcb, so arterial oxygen tension decreases. Hypoxic pulmonary vasoconstriction(HPV) is an autoregulatory mechanism to redistribute pulmonary blood flow and it prevents severe decrease in arterial oxygen tension. Effects of isoflurane on HPV are controversial in human studies. In this study, we measured intrapulmonary shunt(Qs/Qt) and arterial oxygen tension(PaO2) at two lung ventilation (TLV) and OLV, with and without isoflurane to find whether isoflurane depresses HPV in human or not. METHODS: Twenty adult patients were allocated to control group or isoflurane group. After intubation with a double lumen endotracheal tube, TLV with 100% oxygen was done with continuous intravenous infusion of fentanyl(4 mcg/kg/hr) and midazolam(0.1 mgfkg/hr). Pulmonary arterial catheter was inserted via right internal jugular vein. Hemodynamic variables and arterial and mixed venous gas analysis were measured as control values during TLV at decubitus position. For separated ventilation, the dependent lung was ventilated with 100% oxygen, the nondependent lung with 100% nitrogen. Isoflurane(1.2 vo1.%) was administered in isoflurane group and no inhalational agent was administered in control group. RESULTS: In both groups, during OLV Qs/Qt increased and PaO2 decreased significantly compared to TLV. But there was no difference in degrees between two groups. CONCLUSION: Isoflurane of 1.2 vo1.% at end expiratory state does not inhibit HPV significantly in human.

Effects of Isoflurane on Hypoxic Pulmonary Vasocontriction in Human during One Lung Ventilation / 대한마취과학회지

BACKGROUND: During one lung ventilation(OLV), the nonventilated lung profounds ventilation/ perfusion mismatcb, so arterial oxygen tension decreases. Hypoxic pulmonary vasoconstriction(HPV) is an autoregulatory mechanism to redistribute pulmonary blood flow and it prevents severe decrease in arterial oxygen tension. Effects of isoflurane on HPV are controversial in human studies. In this study, we measured intrapulmonary shunt(Qs/Qt) and arterial oxygen tension(PaO2) at two lung ventilation (TLV) and OLV, with and without isoflurane to find whether isoflurane depresses HPV in human or not. METHODS: Twenty adult patients were allocated to control group or isoflurane group. After intubation with a double lumen endotracheal tube, TLV with 100% oxygen was done with continuous intravenous infusion of fentanyl(4 mcg/kg/hr) and midazolam(0.1 mgfkg/hr). Pulmonary arterial catheter was inserted via right internal jugular vein. Hemodynamic variables and arterial and mixed venous gas analysis were measured as control values during TLV at decubitus position. For separated ventilation, the dependent lung was ventilated with 100% oxygen, the nondependent lung with 100% nitrogen. Isoflurane(1.2 vo1.%) was administered in isoflurane group and no inhalational agent was administered in control group. RESULTS: In both groups, during OLV Qs/Qt increased and PaO2 decreased significantly compared to TLV. But there was no difference in degrees between two groups. CONCLUSION: Isoflurane of 1.2 vo1.% at end expiratory state does not inhibit HPV significantly in human.