目的 探讨1例特发性肺纤维化合并冠心病患者行双肺移植同期冠状动脉旁路移植术治疗的效果。方法 1例特发性肺纤维化合并冠心病患者,男,55岁,于体外膜肺氧合辅助下行双肺移植同期冠状动脉旁路移植术。建立静脉-静脉体外膜肺氧合后患者先...目的 探讨1例特发性肺纤维化合并冠心病患者行双肺移植同期冠状动脉旁路移植术治疗的效果。方法 1例特发性肺纤维化合并冠心病患者,男,55岁,于体外膜肺氧合辅助下行双肺移植同期冠状动脉旁路移植术。建立静脉-静脉体外膜肺氧合后患者先取右侧卧位,左后外侧第5肋间切口进胸,游离左乳内动脉,与左冠状动脉前降支行端侧吻合;然后切除左侧病肺,行左肺移植术;变换体位为左侧卧位,经右后外侧第5肋间切口进胸,切除右侧病肺,行右肺移植术。肺动脉开放前予以甲泼尼龙诱导免疫。供体器官为院外脑死亡捐献,与受者血型相同。结果 手术过程顺利,术中出血量700 mL,手术时间8.7 h,冠状动脉旁路移植术时间2.7 h。供体左肺冷缺血时间7.25 h,右肺冷缺血时间10.4 h。术后3 h行X线胸片检查显示患者移植肺纹理清晰,膨胀好,与胸腔大小匹配良好。术后16 h撤除体外膜肺氧合系统,体积分数60%氧浓度下,pa(O_(2)) 127 mm Hg,较术前(76.1 mm Hg)明显增高。术后第1天患者出现低心排血量综合征,超声心动图显示左室射血分数39%,肺动脉压37 mm Hg,左心室室壁搏动减弱,给予强心药物等治疗后好转。术后第2天患者出现中度移植物失功,肺泡灌洗液微生物第二代宏基因测序提示肺炎克雷伯菌、脑膜炎败血伊丽莎白菌感染,在原抗感染方案基础上加用替加环素加强抗感染治疗;超声心动图显示左室射血分数63%,肺动脉压28 mm Hg,左心室舒张功能下降。术后第6天行气管切开以便于气道管理。术后第7天气道分泌物减少,可床上活动。术后第8天下床活动,可间断脱离呼吸机,体积分数40%氧浓度下,心率116次/min,律齐,血压126/92 mm Hg,血氧饱和度98%,pa(O_(2)) 102 mm Hg,pa(CO_(2)) 36 mm Hg。目前继续恢复中。结论 特发性肺纤维化合并冠心病患者行双肺移植同期冠状动脉旁路移植术早期效果良好,远期效果待观察。展开更多
Background Young children are susceptible to pulmonary injury, and acute lung injury （ALl） often results in a high mortality and financial costs in pediatric patients. A good ALl model will help us to gain a better ...Background Young children are susceptible to pulmonary injury, and acute lung injury （ALl） often results in a high mortality and financial costs in pediatric patients. A good ALl model will help us to gain a better understanding of the real pathophysiological picture and to evaluate novel treatment approaches to acute respiratory distress syndrome （ARDS） more accurately and liberally. This study aimed to establish a hemodynamically stable and reproducible model with ALl in piglet induced by oleic acid. Methods Six Chinese mini-piglets were used to establish ALl models by oleic acid. Hemodynamic and pulmonary function data were measured. Histopathological assessment was performed. Results Mean blood pressure, heart rate （HR）, cardiac output （CO）, central venous pressure （CVP） and left atrial pressure （LAP） were sharply decreased after oleic acid given, while the mean pulmonary arterial pressure （MPAP） was increased in comparison with baseline （P 〈0.05）. pH, arterial partial pressure of 02 （PaO2）, PaO2/inspired 02 fraction （FiO2） and lung compliance decreased, while PaCO2 and airway pressure increased in comparison with baseline （P 〈0.05）. The lung histology showed severe inflammation, hyaline membranes, intra-alveolar and interstitial hemorrhage. Conclusion This experiment established a stable model which allows for a diversity of studies on early lung injury.展开更多
Background Cardiopulmonary bypass （CPB） has been shown to be associated with a systemic inflammatory response leading to postoperative organ dysfunction. Elucidating the underlying mechanisms and developing protecti...Background Cardiopulmonary bypass （CPB） has been shown to be associated with a systemic inflammatory response leading to postoperative organ dysfunction. Elucidating the underlying mechanisms and developing protective strategies for the pathophysiological consequences of CPB have been hampered due to the absence of a satisfactory recovery animal model. The purpose of this study was to establish a good rat model of CPB to study the pathophysiology of potential complications. Methods Twenty adult male Sprague-Dawley rats weighing 450-560 g were randomly divided into a CPB group （n=10） and a control group （n=10）. All rats were anaesthetized and mechanically ventilated. The carotid artery and jugular vein were cannulated. The blood was drained from the right atrium via the right jugular and transferred by a miniaturized roller pump to a hollow fiber oxygenator and back to the rat via the left carotid artery. Priming consisted of 8 ml of homologous blood and 8 ml of colloid. The surface of the hollow fiber oxygenator was 0.075 m~. CPB was conducted for 60 minutes at a flow rate of 100-120 ml. kg-1. min-1 in the CPB group. Oxygen flow/perfusion flow was 0.8 to 1.0, and the mean arterial pressure remained 60-80 mmHg. Blood gas analysis, hemodynamic investigations, and lung histology were subsequently examined. Results All CPB rats recovered from the operative process without incident. Normal cardiac function after successful weaning was confirmed by electrocardiography and blood pressure measurements. Mean arterial pressure remained stable. The results of blood gas analysis at different times were within the normal range. Levels of IL-113 and TNF-a were higher in the lung tissue in the CPB group （P 〈0.005）. Histological examination revealed marked increases in interstitialcongestion, edema, and inflammation in the CPB group. Conclusion This novel, recovery, and reproducible minimally invasive CPB model may open the field for various studies on the pathophysiological process of CPB and systemic ischemia-reperfusion injury in vivo.展开更多
Background Pediatric patients are susceptible to lung injury that does not respond to traditional therapies. Total liquid ventilation has been developed as an alternative ventilatory strategy for severe lung injury. T...Background Pediatric patients are susceptible to lung injury that does not respond to traditional therapies. Total liquid ventilation has been developed as an alternative ventilatory strategy for severe lung injury. The aim of this study is to investigate the effect of total liquid ventilation on oleic acid （OA）-induced lung injury in piglets. Methods Twelve Chinese immature piglets were induced acute lung injury by OA. Twelve piglets were randomly treated with conventional gas ventilation （control group） or total liquid ventilation （study group） for 240 minutes. Samples for blood gas analysis were collected before, and at 60-minute intervals after OA-induced lung injury. The degree of lung injury was quantified by histologic examination. The inflammatory cells and the levels of IL-1β, IL-6, IL-10 and TNF-α in plasma, tissue and bronchoalveolar lavage were analyzed. Results Neutrophil and macrophage counts in bronchoalveolar lavage were significantly decreased in the study group （P〈0.05）. The total lung injury score was also reduced in the study group （P〈0.05）. The concentrations of IL-1β, IL-6, IL-10 and TNF-α in plasma, tissue and bronchoalveolar lavage were significantly reduced in the study group （P〈0.05）. Conclusions Total liquid ventilation reduces biochemical and histoloaic OA-induced luna iniurv in nialets.展开更多
文摘目的 探讨1例特发性肺纤维化合并冠心病患者行双肺移植同期冠状动脉旁路移植术治疗的效果。方法 1例特发性肺纤维化合并冠心病患者,男,55岁,于体外膜肺氧合辅助下行双肺移植同期冠状动脉旁路移植术。建立静脉-静脉体外膜肺氧合后患者先取右侧卧位,左后外侧第5肋间切口进胸,游离左乳内动脉,与左冠状动脉前降支行端侧吻合;然后切除左侧病肺,行左肺移植术;变换体位为左侧卧位,经右后外侧第5肋间切口进胸,切除右侧病肺,行右肺移植术。肺动脉开放前予以甲泼尼龙诱导免疫。供体器官为院外脑死亡捐献,与受者血型相同。结果 手术过程顺利,术中出血量700 mL,手术时间8.7 h,冠状动脉旁路移植术时间2.7 h。供体左肺冷缺血时间7.25 h,右肺冷缺血时间10.4 h。术后3 h行X线胸片检查显示患者移植肺纹理清晰,膨胀好,与胸腔大小匹配良好。术后16 h撤除体外膜肺氧合系统,体积分数60%氧浓度下,pa(O_(2)) 127 mm Hg,较术前(76.1 mm Hg)明显增高。术后第1天患者出现低心排血量综合征,超声心动图显示左室射血分数39%,肺动脉压37 mm Hg,左心室室壁搏动减弱,给予强心药物等治疗后好转。术后第2天患者出现中度移植物失功,肺泡灌洗液微生物第二代宏基因测序提示肺炎克雷伯菌、脑膜炎败血伊丽莎白菌感染,在原抗感染方案基础上加用替加环素加强抗感染治疗;超声心动图显示左室射血分数63%,肺动脉压28 mm Hg,左心室舒张功能下降。术后第6天行气管切开以便于气道管理。术后第7天气道分泌物减少,可床上活动。术后第8天下床活动,可间断脱离呼吸机,体积分数40%氧浓度下,心率116次/min,律齐,血压126/92 mm Hg,血氧饱和度98%,pa(O_(2)) 102 mm Hg,pa(CO_(2)) 36 mm Hg。目前继续恢复中。结论 特发性肺纤维化合并冠心病患者行双肺移植同期冠状动脉旁路移植术早期效果良好,远期效果待观察。
基金This study was supported-by grants from the National Natural Science Foundation of China （No. 30670928, No. 81070055） and the Beijing Municipal Education Commission （No. PXM2011_014226_07 000060, Z11110006150000）.
文摘Background Young children are susceptible to pulmonary injury, and acute lung injury （ALl） often results in a high mortality and financial costs in pediatric patients. A good ALl model will help us to gain a better understanding of the real pathophysiological picture and to evaluate novel treatment approaches to acute respiratory distress syndrome （ARDS） more accurately and liberally. This study aimed to establish a hemodynamically stable and reproducible model with ALl in piglet induced by oleic acid. Methods Six Chinese mini-piglets were used to establish ALl models by oleic acid. Hemodynamic and pulmonary function data were measured. Histopathological assessment was performed. Results Mean blood pressure, heart rate （HR）, cardiac output （CO）, central venous pressure （CVP） and left atrial pressure （LAP） were sharply decreased after oleic acid given, while the mean pulmonary arterial pressure （MPAP） was increased in comparison with baseline （P 〈0.05）. pH, arterial partial pressure of 02 （PaO2）, PaO2/inspired 02 fraction （FiO2） and lung compliance decreased, while PaCO2 and airway pressure increased in comparison with baseline （P 〈0.05）. The lung histology showed severe inflammation, hyaline membranes, intra-alveolar and interstitial hemorrhage. Conclusion This experiment established a stable model which allows for a diversity of studies on early lung injury.
基金This study was supported by grants from the Capital Medical University-Clinical Research Cooperation Fund （No. l lJLS0, No. 13JL26）, the National Natural Science Foundation of China （No. 81371443, No. 81070055）, Beijing Natural Science Foundation （No. 7112046, No. 7122056）, Beijing Health System High Level Health Technical Personnel Training Plan （No. 2011-1-4）, and the Specialized Research Fund for the Doctoral Program of Higher Education （SRFDP, No. 20111107110006）.
文摘Background Cardiopulmonary bypass （CPB） has been shown to be associated with a systemic inflammatory response leading to postoperative organ dysfunction. Elucidating the underlying mechanisms and developing protective strategies for the pathophysiological consequences of CPB have been hampered due to the absence of a satisfactory recovery animal model. The purpose of this study was to establish a good rat model of CPB to study the pathophysiology of potential complications. Methods Twenty adult male Sprague-Dawley rats weighing 450-560 g were randomly divided into a CPB group （n=10） and a control group （n=10）. All rats were anaesthetized and mechanically ventilated. The carotid artery and jugular vein were cannulated. The blood was drained from the right atrium via the right jugular and transferred by a miniaturized roller pump to a hollow fiber oxygenator and back to the rat via the left carotid artery. Priming consisted of 8 ml of homologous blood and 8 ml of colloid. The surface of the hollow fiber oxygenator was 0.075 m~. CPB was conducted for 60 minutes at a flow rate of 100-120 ml. kg-1. min-1 in the CPB group. Oxygen flow/perfusion flow was 0.8 to 1.0, and the mean arterial pressure remained 60-80 mmHg. Blood gas analysis, hemodynamic investigations, and lung histology were subsequently examined. Results All CPB rats recovered from the operative process without incident. Normal cardiac function after successful weaning was confirmed by electrocardiography and blood pressure measurements. Mean arterial pressure remained stable. The results of blood gas analysis at different times were within the normal range. Levels of IL-113 and TNF-a were higher in the lung tissue in the CPB group （P 〈0.005）. Histological examination revealed marked increases in interstitialcongestion, edema, and inflammation in the CPB group. Conclusion This novel, recovery, and reproducible minimally invasive CPB model may open the field for various studies on the pathophysiological process of CPB and systemic ischemia-reperfusion injury in vivo.
基金This study was supported by grants from the National Natural Science Foundation of China （No. 81070055）, Beijing Science and Technology Commission （No. ZI 11100074911001 ）, Beijing Natural Science Foundation （No. 7112046, No. 7122056）, Beijing Health System High Level Health Technical Personnel Training Plan （No. 2011-1-4）, and Basic and Clinical Cooperation Project of Capital Medical University （No. 13JL26）.
文摘Background Pediatric patients are susceptible to lung injury that does not respond to traditional therapies. Total liquid ventilation has been developed as an alternative ventilatory strategy for severe lung injury. The aim of this study is to investigate the effect of total liquid ventilation on oleic acid （OA）-induced lung injury in piglets. Methods Twelve Chinese immature piglets were induced acute lung injury by OA. Twelve piglets were randomly treated with conventional gas ventilation （control group） or total liquid ventilation （study group） for 240 minutes. Samples for blood gas analysis were collected before, and at 60-minute intervals after OA-induced lung injury. The degree of lung injury was quantified by histologic examination. The inflammatory cells and the levels of IL-1β, IL-6, IL-10 and TNF-α in plasma, tissue and bronchoalveolar lavage were analyzed. Results Neutrophil and macrophage counts in bronchoalveolar lavage were significantly decreased in the study group （P〈0.05）. The total lung injury score was also reduced in the study group （P〈0.05）. The concentrations of IL-1β, IL-6, IL-10 and TNF-α in plasma, tissue and bronchoalveolar lavage were significantly reduced in the study group （P〈0.05）. Conclusions Total liquid ventilation reduces biochemical and histoloaic OA-induced luna iniurv in nialets.
