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find Keyword "肺移植" 51 results
  • Hemodynamic Monitoring by Pulse-Indicated Continuous Cardiac Output Analysis During Lung Transplantation

    Objective To explore the hemodynamic monitoring value of pulse-indicated continuous cardiac output( PiCCO) during lung transplantation. Methods Twenty patients with end-stage lung disease undergone lung transplantation were enrolled. Hemodynamic states were monitored by PiCCO and Swan-Ganz standard thermodilution pulmonary artery catheter( PAC) simultaneously at six stages throughout the study. Changes in the variables were calculated by subtracting the first fromthe second measurement( Δ1 ) and so on ( Δ1 to Δ5 ) . Results The linear correlation between intra-thoracic blood volume index( ITBVI) and stroke volume index( SVIpa) was significant ( r = 0. 654, P lt; 0. 05) , whereas pulmonary artery wedge pressure ( PAWP) poorly correlated with SVIpa( P gt; 0. 05) . Changes in ITBVI correlated with changes in SVIpa ( Δ1 , r =0. 621; Δ2 , r = 0. 784; Δ3 , r = 0. 713; Δ4 , r = 0. 740; Δ5 , r = 0. 747; all P lt; 0. 05) , whereas PAWP failed. The mean bias between CIart and CIpa was ( 0. 09 ±0. 5) L·min-1 ·m-2 ; the limit of agreement was ( - 0. 89 ~1. 07) L·min-1 ·m-2 . Conclusions There is good correlation between the two methods of PiCCO and PAC for reflecting the change of heart preload. PiCCO is reliable in hemodynamic monitoring in patients undergone lung transplantation.

    Release date:2016-08-30 11:53 Export PDF Favorites Scan
  • Diagnosis and Treatment of Primary Graft Dysfunction after Lung Transplantation: Report of 10 Cases

    Objective To summarize the clinical manifestations, diagnosis and treatment of severe primary graft dysfunction ( PGD grade 3 ) in early stage after lung transplantation. Methods From September 2002 to December 2010, there were 10 patients with severe PGD ( grade 3) in early stage after lung transplantation ( LTx) in 100 patients with end-stage lung disease underwent LTx in Wuxi People’s Hospital. In which there were 2 cases with chronic obstructive pulmonary disease, 4 with idiopathic pulmonary fibrosis,1 case with lung tuberculosis, 1 case with silicosis, 2 cases with bronchiectasis. There were 7 patients with single LTx [ 3 cases with extracorporeal membrane oxygenation ( ECMO) support] and 3 patients with bilateral LTx ( 1 case with ECMO support) . Results The surgical procedures of these 10 patients were successful, however severe PGD occurred on 1-5 days after operation. 4 cases died of respiratory failure with negative fluid balance and mechanical ventilation support, and 2 cases recovered. 4 cases underwent ECMO support, in which 2 cases successfully weaned from ECMO and discharged from hospital, others died of multiple organ failure.Conclusions Severe PGD is one of the fatal early complication after lung transplantation. Early diagnosis and treatment are very important to improve the perioperative mortality rate.

    Release date:2016-09-13 04:00 Export PDF Favorites Scan
  • Analysis of Clinical Outcomes of Lung Volume Reduction Surgery and Lung Transplantation on End-stage Emphysema

    Abstract: Objective To evaluate the clinical effects and health economics of lung volume reduction surgery(LVRS), single lung transplantation(SLTx) and bilateral lung transplantation(BLTx) for patients with end-stage emphysema. Methods A total of 61 patients with end-stage emphysema, including 39 patients who underwent LVRS(LVRS group), 14 patients who underwent SLTx(SLTx group), and 8 patients who underwent BLTx(BLTx group) from September 2002 to August 2008 in Wuxi People’s Hospital, were analyzed retrospectively. Lung function, arterial blood gas analysis and 6-minute walk distance(6-MWD)were assessed before their surgery and 6 months, 1-year and 3-year after their surgery respectively. Their 1-year and 3-year survival rates were observed. Cost-effectiveness analyses were made from a health economics perspective. Results Compared with their preoperative results, their mean forced expiratory volume in 1 second(FEV1.0)in LVRS group increased by 75%, 83% and 49% at 6 months, 1-year and 3-year postoperatively, by 176%, 162% and 100% in SLTx group, and by 260%, 280% and 198% in BLTx group respectively. Their mean forced vital capacity(FVC)in LVRS group increased by 21%, 41% and 40% at 6 months, 1-year and 3-year postoperatively, by 68% , 73% and 55% in SLTx group, and by 82%, 79% and 89% in BLTx group respectively. Their exercise endurance as measured by 6-MWD increased by 75%, 136% and 111% in LVRS group at 6 months, 1-year and 3-year postoperatively, by 513%, 677% and 608% in SLTx group, and by 762%, 880% and 741% in BLTx group respectively. The 1-year and 3-year survival rates after operation were 74.40% and 58.90% in LVRS group, 85.80% and 64.30% in SLTxgroup, and 62.50% and 50.00% in BLTx group respectively. The three years’ cost utility of SLTx group was significantly higher than that of BLTx group(1 668.00 vs.1 168.55, P< 0.05)and LVRS group (1 668.00 vs. 549.46, P< 0.05). Conclusion SLTx and BLTx are better than LVRS in improving patients’ lung function and exercise endurance for end-stage emphysema patients. LVRS is more cost-effective than SLTx and BLTx in the early postoperative period. With the development of medical technology and decreased expenses of lung transplantation and immunosuppressive agents, lung transplantation will become the first surgical choice for end-stage emphysema patients.

    Release date:2016-08-30 05:49 Export PDF Favorites Scan
  • 参附注射液对兔移植肺缺血再灌注损伤的保护作用

    目的 观察参附注射液对供肺缺血再灌注损伤的保护作用。 方法 将20只新西兰白兔随机分为实验组和对照组,每组各10只,建立兔左肺自体原位移植模型,分别用参附注射液和生理盐水对兔肺进行预处理和供肺灌注。于主动脉阻断前、再灌注后15 min、30 min和60 min各时点检测左肺静脉血中丙二醛(MDA)含量、总超氧化物歧化酶(SOD)的活力,于再灌注60 min后称左肺组织的干湿比重(D/W),并观察其病理变化。 结果 主动脉阻断前两组MDA含量差异无统计学意义(Pgt;0.05);再灌注15 min后实验组MDA含量较主动脉阻断前下降;再灌注30 min和60 min时,两组MDA含量均呈上升趋势,但实验组明显低于对照组(Plt;0.05)。主动脉阻断前实验组SOD活力明显高于对照组(Plt;0.05),再灌注后两组SOD活力均呈下降趋势,以对照组下降幅度明显(Plt;0.05)。实验组的D/W显著高于对照组(0.23±0.01 vs. 0.19±0.02,Plt;0.05)。对照组肺组织水肿明显,大量的炎性细胞浸润,肺泡腔内有片状渗出;而实验组表现为肺泡间隔水肿轻微,少量炎细胞浸润,渗出不明显。 结论 参附注射液对供肺的缺血再灌注损伤有较好的保护作用。

    Release date:2016-08-30 06:02 Export PDF Favorites Scan
  • 大鼠左肺原位移植模型的改进

    目的 建立改进的大鼠左肺原位移植模型,使大鼠肺移植模型的建立更加简便、有效和稳定。 方法 将40只SD大鼠随机配对,采用三袖套法进行肺动、静脉的吻合,内支架进行支气管重建,建立大鼠肺移植模型。 结果 进行大鼠左肺原位移植正式实验20对,供肺灌注到摘取时间为15±3 min,供肺完成体外套管时间为5±2 min,供、受体动静脉和支气管套管吻合时间为30±3 min,总手术时间63±4 min。手术成功18只,手术成功率90%;失败2只,其中操作失误死亡1只,肺静脉撕裂1只。血气、病理学等检查证实成功复制了肺移植缺血再灌注模型。 结论 改进的大鼠左肺原位移植模型操作简便,成功率高,值得推广和应用。

    Release date:2016-08-30 06:05 Export PDF Favorites Scan
  • The Clinical Analysis of 65 Cases with Lung Transplantation

    Objective To investigate the experience of operative technique of donor organ harvesting and lung transplantation in some unusual circumstance, and to improve surgical success ratio of lung transplantation. Methods Lung transplants were preformed in 65 cases, including 47 singlelung transplants and 18 double single lung transplants. All the recipients were suffered from intensive respiratory failure,and nine patients were longterm ventilatordependented of the total. The recipients included emphysema (n=23), pulmonary fibrosis (n=24), pneumosilicosis(n=5), pulmonary tuberculosis(n=2), lymphangioleiomyomatosis(n=1) and ventricular septal defect(VSD) or VSD with Eisenmenger’s syndrome(n=4),bronchiectasis (n=4), diffuse panbronchiolitis (n=1) and primary pulmonary hypertension(n=1). Retrospectively summarize clinical experience of lung transplant operation especially experience of dealing with special circumstances encountered in operation. Results 64 donor organ harvesting were achieved successfully. Inhospital death was 11cases (16.9%) after operation. Early death was due to primary lung graft dysfunction (n=3), severe infection(n=6), acute rejection(n=1), pulmonary vein embolism(n=1). Complications took place after operation in 9 cases, to exploratory thoracotomy to stop bleeding after transplantation in 3 cases, pulmonary artery anastomosis again because of stenosis in 1 case, bronchus stoma stenosis in 3 cases, pulmonary infarction in 2 cases, of which one patient accepted pulmonary lobectomy. Follow-up period was from 1.0 year to 5.6 years of 54 cases. 1year survival rate was 72.3%(47/65).The pulmonary function was improved and the quality of life is well in most patients of the group. Conclusion To improve the technique of donor organ harvesting and lung transplantation is important to decrease the early mortality after transplantation.

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • 右肺移植同期行左肺减容术一例

    目的 探讨单肺移植术后对患者长期生存的影响因素,可能的干预措施。 方法 2004年7月我院对1例慢性阻塞性肺病(COPD)患者施行右肺移植,并同期行左肺减容术;随访观察3年来的肺功能、肝功能、免疫抑制剂血浓度、胸部CT以及治疗情况等。 结果 患者行肺移植术后肺功能第1秒用力呼气容积(FEV1.0)实测值占预计值的59.0%(1.97/3.34),最大通气量(MVV)实测值占预计值的642%(79.24/123.36),较术前明显改善(Plt;0.05)[FEV1.0实测值占预计值的14.2%(0.47/3.30),MVV实测值占预计值的11.4%(13.98/122.23)];因使用免疫抑制剂而反复出现肺结核菌等感染,抗结核等治疗加重肝损害;血液环孢素浓度波动不大;CT检查示移植肺情况较稳定而左肺气肿呈现加重趋势。 结论 单肺移植是治疗终末期肺部疾病的有效方法,但术后并发症较多,积极有效地预防和治疗有助于其长期生存。

    Release date:2016-08-30 06:09 Export PDF Favorites Scan
  • Effect of Astilbin on Lung Allograft Rejection in Rats’ Transplantation Model

    Objective To investigate the suppression effect and mechanism of Astilbin on lung allograft rejection in rats, in order to know the function of Astilbin on rats’ lung acute rejection. Methods The model of rat left lung transplantation was set up. Sixty lung transplanted rats were divided into two groups randomly, control group: rats were fed with normal saline 1ml per day, experimental group: rats were fed with Astilbin 1mg/kg per day. Survival time, transforming rate of T cells in spleen, activity of interleukin 2 (IL-2) in spleen lymph cells and apoptosis of T cells were observed. Changes in ultrastructure of pulmonary arteries were observed by electron microscope. Results The survival time in experimental group was prolonged than that in control group (25.4±2.1 d vs. 13.4±1.2 d;t=2.042, Plt;0.05). Transforming rate of T cells of spleen in experimental group was significant lower than that in control group (23 465.8±8 783.4 cpm vs. 74 567.3±12 874.6 cpm; t=2.284,Plt;0.05).Activity of IL-2 of spleen lymph cells in experimental group was significant lower than that in control group (425±2.65U/ml vs. 23.46±1.82U/ml; t=3.165, Plt;0.01).Effectively derive apoptosis of activated T cells in acute rejection were observed in experimental group, the ultrastructure of pulmonary arteries showed attenuated injury in experimental group. Conclusion Astilbin decreased the IL-2 concentration in plasma and induced the apoptosis in activated T cells, then suppressed the acute rejection of lung allograft and prolonged the survival period of lung transplantation rats.

    Release date:2016-08-30 06:09 Export PDF Favorites Scan
  • 右侧单肺移植术治疗双肺多发性囊肿合并感染一例

    目的 总结单肺移植术治疗终末期肺部疾病的手术技术和围手术期处理经验。 方法 2006年1月为1例双肺多发性囊肿合并感染患者施行了右侧单肺移植手术。 结果 术后用同步间隙指令性通气(SIMV)模式辅助呼吸48h后拔除气管内插管。胸部X线片和CT示:移植肺清晰,肺扩张和血液灌注良好,未见异常密度阴影。与术前比较,患者术后肺功能明显提高,第一秒用力呼出量(FEV1)增加0.74L,最大通气量(MVV)增加31.08L/min。住院64d痊愈出院。出院后5个月余肺功能正常,MVV%为66.0%,大小气道功能和肺通气储备功能接近正常。随访1年患者身体健康,恢复正常生活和工作。 结论 有明确的手术适应证、良好的肺保存、移植技术和合理的围术期处理是提高肺移植手术患者治疗效果和生活质量的保证。

    Release date:2016-08-30 06:15 Export PDF Favorites Scan
  • Progress of Lung Preservation Solution in Lung Transplantation

    Abstract: Although lung transplantation has been established as the only valid therapeutic approach for endstage pulmonary disease, several related problems remain to be solved. In addition to the serious problem in donor lung shortage, primary graft dysfunction caused by lung ischemia-reperfusion injury is one of the most common reason of early mortality. Optimal preservation of lung is essential to reduce ischemic organ dysfunction after lung transplantation. The development of a highly reliable lung preservation solution that reduces ischemia-reperfusion injury will improve the functioning of transplanted lungs. The progress of the type, perfusing technique or strategies and modified methods of lung preservation solution are reviewed in this article.

    Release date:2016-08-30 06:15 Export PDF Favorites Scan
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