Abstract： Ischemia postconditioning is a new concept based on ischemic preconditioning. It has become a hot topic in protection of ischemic-reperfusion injury because of its effective protection, relative ease of application, and postconditioning. However, its precise mechanisms and most effective application methods are still unclear. This review covers recent progress in the understanding, developments (in remote postconditioning and pharmacological postconditioning), applications to the protection of heart, lung, liver, kidney, and brain, mechanisms and appropriate protocol of ischemic post-conditioning.
Objective To evaluate the efficacy of lung-protective strategies of ventilation (LPSV) in acute respiratory distress syndrome (ARDS) patients after thoracic operation. Methods-Thirtyseven ARDS patients without preoperative complications who had underwent thoracic surgery successfully were divided into the conventional mechanical ventilation group (CMV group, n=20) and lungprotective strategies of ventilation group (LPSV group，n=17). Results of arterial blood gas, index of oxygenation (PaO2/FiO2), airway plateau pressure (Pplat), inspiration peak pressure (PIP), PEEP, after ventilation treatment 24 h and mechanical ventilation time， pulmonary barotrauma and so on were observed. Results The mechanical ventilation time， pulmonary barotrauma and mortality of the LPSV group were 7.3d, 5.9％ and 29.4％ respectively, which were significantly better than those in the CMV group(17.6d，15.0％ and 60.0％, Plt;0.05). peak inflation pressure (PIP)，Pplat(plat pressure) in the LPSV group were significantly lower than those in the CMV group (Plt;0.05). However, there were no significant differences including arterial oxygen saturation (SaO2),pH, partial pressure of carbon dioxide in artery (PaCO2) and PaO2/FiO2 in two groups. Conclusion LPSV is more effective for the patients in the ARDS patients after thoracic operation compared to CMV, which can markedly reduce the ventilatorinduced lung injuryand (VILI) and mortality.
Objective To systematically review the efficacy of ambroxol for lung protection in perioperative period. Methods We followed the Cochrane Collaboration methodology to conduct systematic reviews. We searched relevant randomized controlled trials (RCTs) from The Cochrane Library, PubMed, Embase, CBM, CNKI and VIP. We assessed the methodological quality for each outcome by grading the quality, and used RevMan5.0.0 to perform meta-analysis. Results Eight RCTs were eligible and included 669 patients. All of these trials used randomization but the quality scales were B. Compared to the control group, the ambroxol group had a statistically significant benefit in atelectasis, pulmonary complications, cough and expectoration degree. The RR (95%CI) were 0.44 (0.25, 0.78), 0.51 (0.34, 0.75), 0.39 (0.16, 0.94) and 0.22 (0.09, 0.53), respectively. The ambroxol group was also better than the control group in sputum volume, sputum characteristics, rales and pulmonary surfactant. Conclusion Ambroxol can improve respiratory system symptoms post-operatively, reduce pulmonary complications, and prevent pulmonary surfactant from decreasing during operation. Ambroxol has a satisfactory lung protective effect in the preoperative period, but we can’t define a proper dose and usage time.
Objective To study the efficacy of invasive ventilation in critical severe acute respiratory syndrome (SARS). Methods Retrospective analysis was applied to study the efficacy of invasive ventilation and the effect of isolating and protecting measures in 6 critical SARS patients and the effect of isolation measures in ICU from November 2002 to April 2003. Results Six SARS patients were successfully weaned from mechanical ventilation and left hospital. Hypoxemia and oxygenation index（PaO2/FiO2）improved significantly after ventilation (Plt;0.01), peak inspiratory airway pressure (P=0.002), mean airway pressure (P=0.004), and the level of positive expiration end pressure decreased significantly (Plt;0.001). Ventilator-associated pneumonia occurred in 5 patients. Sedatives were used less and the duration of ventilation was shorter when using PRVC compared with SIMV. There was no SARS nosocomial infection among medical staff, other patients and their families. Conclusions Application of invasive ventilation and effective isolation measures could reduce the death rate, shorten the duration of ventilation, and also decrease SARS nosocomial infection.
目的 探讨体外循环（CPB）期间行肺动脉灌注液对术后肺功能的保护作用。 方法 2007年1月－2011年4月30例在CPB下行单纯二尖瓣人工机械瓣置换术患者，随机分成肺保护组和对照组各15例，肺保护组患者CPB期间经肺动脉灌注低温肺保护液，对照组患者CPB期间未经肺动脉灌注低温肺保护液。监测两组患者在麻醉诱导后、阻断主动脉l0 min及开放主动脉l0 min，2 、12、24 h各时间点的呼吸指数（RI）、氧合指数（OI）、白介素6（IL-6）、肿瘤坏死因子α（TNF-α）及术前、术后肺动脉压力（PAPm）、静态肺顺应性（CLS）、气道阻力（AR）变化，并比较术后ICU监护时间、术后呼吸机辅助时间、住院天数及有无术后并发症等。 结果 两组IL-6、TNF-α、RI、OI、PAPm、AR、CLS比较差异均有统计学意义（P＜0.05）。但术后ICU监护时间及住院时间比较差异均无统计学意义（P＞0.05）。 结论 CPB期间行肺动脉灌注对术后肺功能具有保护作用。
【摘要】 目的 通过观察单肺通气患者术中氧合指数（oxygenation index，OI）、呼吸指数（respiratory index，RI）及动态肺顺应性（dynamic lung compliance，Cdyn）的变化，探讨高渗氯化钠溶液对术中单肺通气患者的肺保护作用。 方法 选择2009年12月-2011年2月完成的美国麻醉师协会分级为Ⅰ~Ⅲ级，心肺功能筛查、血常规、肝肾功能及凝血功能无明显异常，拟在全麻双腔气管插管下行开胸手术，术中需行单肺通气患者60例，随机分为高渗氯化钠组（A组）和对照组（B组），每组30例。A组在开始单肺通气后30 min快速输注7.5%高渗氯化钠溶液2 mL/kg，15 min内输注完毕，B组输注等量生理盐水，分别记录输注前（T1）、输注完毕时（T2）、输注后30 min（T3）、输注后1 h（T4）的OI、RI及Cdyn变化，并比较两组各时间点生命体征变化。 结果 两组患者OI、RI及Cdyn在T1、T2时差异无统计学意义（Pgt;0.05）；两组患者不同时间点平均动脉压、心率、脉搏血氧饱和度、中心静脉压、呼气末CO2分压比较差异无统计学意义（Pgt;0.05）；A组患者在T3、T4时的OI和Cdyn较B组明显升高，RI明显降低（Plt;0.05）；且A组患者在T3、T4时的OI和Cdyn较T1时明显增高，RI明显降低（Plt;0.05）。 结论 高渗氯化钠溶液能改善术中单肺通气患者的OI、RI及Cdyn，对肺功能有一定的保护作用。【Abstract】 Objective To observe the oxygenation index (OI), respiratory index (RI) and dynamic lung compliance (Cdyn) changes of the patients with one-lung ventilation, in order to determine if hypertonic saline has lung protective effects. Methods Sixty ASA Ⅰ-Ⅲ patients who needed one-lung ventilation during thoracotomy under general anesthesia with double-lunmen endotracheal tubes were chosen to be the study subjects. No obvious abnormalities were detected by cardiopulmonary function screening, blood test, hepatorenal function and blood coagulation examinations in these patients. They were randomly divided into hypertonic saline group (group A) and control group (group B) with 30 patients in each group. For patients in group A, 30 minutes after one-lung ventilation, infusion of 7.5% hypertonic saline solution at 2 mL/kg was carried out and completed in 15 minutes. For patients in group B, the same amount of saline solution was infused. We recorded OI, RI and Cdyn changes before the infusion (T1), on the completion of the infusion (T2), 30 minutes after the infusion (T3), and 1 hour after the infusion (T4). The changes of vital signs in patients of the two groups were compared. Results OI, RI and Cdyn were not significant different between the two groups at T1 and T2 (Pgt;0.05). Mean arterial pressure (MAP), heart rate (HR), SpO2, central venous pressure (CVP), and PetCO2 were not significant different between the two groups at all time points (Pgt;0.05). OI and Cdyn of group A patients were significantly higher than those of group B, while RI was significantly lower at T3 and T4 (Plt;0.05). Cdyn and OI of group A patients at T3 and T4 were significantly higher when compared with T1, and RI was significantly lower (Plt;0.05). Conclusion Hypertonic saline has the lung protection effect in patients with one-lung ventilation by improving OI, RI and Cdyn.
Acute lung injury is a kind of common complication after cardiopulmonary bypass. Acute lung injury is attributed to the ischemia-reperfusion injury and systemic inflammatory response syndrome. Several factors common in cardiac surgery with cardiopulmonary bypass may worsen the risk for acute lung injury including atelectasis, transfusion requirement, older age, heart failure, emergency surgery and prolonged duration of bypass. Targets for prevention of acute lung injury include mechanical, surgical and anesthetic interventions that aim to reduce the contact activation, systemic inflammatory response, leukocyte sequestration and hemodilution associated with cardiopulmonary bypass. We aim to review the etiology, risk factors and lung protective strategies for acute lung injury after cardiopulmonary bypass.