Objective To investigate the effects of positive end-expiratory pressure (PEEP) level on end-expiratory lung volume (EELV) during assisted ventilation in chronic obstructive pulmonary disease （COPD） patients，to provide physiological evidence to guide optimal setting of PEEP level in clinical practice.Methods Eight intubated patients with acute exacerbation of COPD were recruited for the study when the patients were in relatively stable condition after treatment.The static intrinsic PEEP (PEEPistat) and dynamic intrinsic PEEP (PEEPidyn) were measured by using airway occlusion method and esophageal balloon-tipped catheter technique,respectively.Changes in EELV (ΔEELV) were measured with inspiratory capacity (IC) method.Relations between PEEP level and ΔEELV were analyzed by curve estimation method.Results ΔEELV as a function of level of PEEP was shown as a sigmoid model.The low inflection points of the curves when PEEP levels were expressed as PEEP/PEEPistat ratio，PEEP/PEEPidyn ratio or actual PEEP setting (PEEP-a) were 0.74，0.76 or 3.6 cm H2O,respectively.The corresponding ΔEELV expressed as ΔEELV/IC（%） were 9.6%，9.1% and 7.4%,respectively.Conclusions In AECOPD patients demanding mechanical ventilation，the changes of lung volume (ΔEELV) in response to progressive increase of PEEP level were shown to be a sigmoid model.Setting PEEP level at 0.74 of PEEPistat，or 0.76 of PEEPidyn can avoid the steep increase of lung volume.
Objective To explore the treatment effects of one-way valve lung volume reduction surgery for heterogeneous emphysema.Methods Seven heterogeneous emphysema Beagle dogs were each implanted in right lung2-4 pieces ofbronchial one-way valve.The animals were sacrificed two months later.Macro- and microscopic pathology changes of the lungs were observed.Results Of 21 valves implanted，2 were expectorated，and 19 were in normal position.The dogs did not have obvious adverse reactions.Generally specimens of the occluded lobes had different levels of lung volume decrease，such as texture stiffened，focal scar formation，atelectasis，pulmonary fibrosis.Pathological biopsy showed moderate alveolitis and pulmonary interstitial fibrosis.Conclusion One-way valve lung volume reduction is effective for heterogeneous 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.
Objective To investigate the clinical significance of low dose corticosteroid applied in early period after lung volume reduction surgery（LVRS）. Methods From Apr. 2001 to Mar. 2004, 27 patients with chronic obstructive pulmonary disease were undergone video-assisted unilateral LVRS assisted with mini-incision in our department were retrospectively reviewed. According to whether dispensed with postoperative corticosteroid or not, patients were divided into corticosteroid group and non-corticosteroid group. Corticosteroid group received dexamethasone 10mg iv tid for 3 days and then declined to prednisone 5mg qd for 7 days. Both groups were measured and compared the quantity of thoracic drainage flow, duration of chest tube drainage, the time of air leaks and fever, and so on. At same time, blood gas analysis and blood routine test were performed at 1, 3, 7 and 30 d after operation. Results Corticosteroid and non-corticosteroid groups had no statistically differences in the air leaks time （P 〉 0.05）, but the quantity of thoracic drainage flow of corticosteroid group was lower than that of non-corticosteroid group evidently （700±210ml vs. 950±150ml, P = 0.001）. There was significant difference in average duration of chest tube drainage between both groups （9±3 d vs. 12±2 d, P = 0. 05）. Compared with non-corticosteroidgroup, PaO2 of corticosteroid group was higher at 1, 3d after operation （P〈0.05）. The amount of blood leukocyte of corticosteroid group was lower than that of non-corticosteroid group at 3, 7d after operation, there was no statistically significant in two groups （P 〉 0. 05）. At early period after surgery, both groups had no significant infection and death patient. Conclusion The low dose corticosteroid applied in early period after LVRS for short time（10 days in this research） could shorten the duration of chest tube drainage, decrease the quantity of thoracic drainage flow and the extent of inflammation in pleural cavity. In the mean time, this treatment does not increase the occurrence of significant complications during the early postoperative period, and there is no negative influence to the blood gas analysis.
Objective To investigate the effect of lung volume reduction surgery （LVRS） on messenger RNA expression levels of cytoskeletal proteins in diaphragmatic muscle tissues of emphysematous rabbits. Methods A total of 40 rabbits were randomly divided into 4 groups （10 rabbits in each group） ：normal control group, emphysema group, sham operation group and LVRS group. Rabbits in control group were intratracheally administered with 0.9% normal sodium, but those in other groups were intratracheally administered with 0.4% papain at the dose of 0.5 ml/kg and inhaled cigarette smoke to induce emphysema model. Then, rabbits in emphysema group were fed routinely, however, after median sternotomy , bilateral LVRS was performed in LVRS group but not in sham operation group. The mRNA expression levels of titin and nebulin in the diaphragmatic muscles of rabbits in each group were detected by reverse transcription-polymerase chain reaction（RT-PCR）. Results Compared with control group, the mRNA expression levels of titin and nebulin in the rabbit diaphragm of emphysema groups and sham operation group decreased significantly （P〈0.01 ）, so did those in LVRS group （P〈0.05）. But it increased significantly in LVRS group compared with emphysema group and sham operation group （P〈0.05）. Conclusion LVRS can increase the mRNA expression levels of titin and nebulin in diaphragmatic muscle tissues of emphysematous rabbits, which may be the associated mechanisms at the molecular level in restoring the functions of the emphysematous diaphragm by LVRS.
Lung volume reduction surgery （LVRS） has been applied generally since it was redeveloped and lucubrated. A recent large, multicenter trial showed LVRS can improve lung function, exercise capacity, quality of life, and even survival in certain highly selected patients. LVRS has been developed as an effective therapy for severe emphysema, which offers a new approach for the victims of emphysema. The development of operative technique and clinical effect about LVRS are reviewed in this article.
ObjectiveTo investigate the feasibility and efficacy of staged bilateral single-port thoracoscopic lung volume reduction surgery (LVRS) for the patients with chronic obstructive pulmonary emphysema (COPE). MethodsWe retrospectively analyzed clinical data of eleven male patients with bilateral COPE and bullae in Xuzhou Central Hospital Affiliated to Southeast University from January 2013 through June 2014. All the patients underwent staged bilateral single-port thoracoscopic LVRS with their age of 60.27± 12.11 years. The hyperinflated bullae were resected using endoscopic staplers (Endo-GIA), followed by continuous suture and biological glue for reinforcement of the margin. Besides, the pulmonary function, blood gas assay, 6-minute walk distance (6-MWD), and life quality evaluated by short form 36 Health survey questionnaire (SF-36) were recorded before and after LVRS respectively. ResultsAll the patients survived after surgery. Chest tube drainage time was 9.09± 1.31 days. Postoperative hospital stay was 15.73± 2.75 days. There were 5 patients with persistent air leakage and 7 patients with pulmonary infection who were cured finally. The pulmonary function, arterial partial pressure of oxygen(PaO2), 6-MWD and life quality after unilateral or bilateral LVRS improved than those before surgery in postoperative 3 months. However, there was no statistical difference in outcomes between unilateral and bilateral LVRS patients. ConclusionStaged bilateral single-port thoracoscopic LVRS could improve short-term life quality of patients with COPE.
Objective To investigate the changes of pulmonary circulation and right ventricular function after lung volume reduction surgery. Methods We retrospectively analyzed the clinical data of 34 patients of severe chronic obstructive pulmonary disease with single or double lung volume reduction surgery through thoracoscope in our hospital from 2013 through 2014. Ultrasonic testing was conducted peroperatively, on postoperative day 3–5, at 1 month and 3 months after surgery. Results Right ventricular stroke volume (61.00±10.54 ml vs. 38.34±10.04 ml) and right ventricular ejection fraction decreased (58.00%±9.00% vs. 49.00%±10.00%), mean pulmonary arterial pressure (23.35±5.07 mm Hg vs. 29.57±6.32 mm Hg) and total pulmonary vascular resistance (9.28±2.14 mm Hg vs. 12.05±4.36 mm Hg) increased with statistical differences (P＜0.05) on postoperative day 3–5. Right heart ejection fraction was 51%±11% with a statistical increase (P＜0.05) at 1 month after surgery. There was no statistical difference in indicators above between 3 months after surgery and before surgery. Conclusion Changes of pulmonary circulation and right ventricular function may be temporary. Right ventricular dysfunction decreases, pulmonary arterial pressure, and total pulmonary vascular resistance increases on postoperative day 3–5 d. But the changes gradually recover in 1–3 months after surgery, and could be gradually restored to preoperative level.