Arterial Duct Stenting Versus Modified Blalock-Taussig Shunt in Patient with Ductal-Dependent Pulmonary Circulation: Systematic Review & Meta-Analysis

Objective:Patients with ductal-dependent pulmonary circulation require alternative bloodflow to provide and maintain adequate oxygenation.Modified Blalock-Taussig Shunt(MBTS)has been the standard for providing such a result.Currently,less invasive methods such as Arterial Duct(AD)stenting have been performed as alter-natives.This study aims to compare the outcome of AD stenting and MBTS.Method:Systematic research was performed in online databases using the PRISMA protocol.The outcomes measured were 30-day mortality,com-plication,unplanned intervention,oxygen saturation,duration of hospital,and ICU length of stay.Any compara-tive study provided with full text is included.The outcome of each study was analyzed using a trandom effects model with relative risk and mean difference as the effect size.Bias risk assessment was conducted using the New-castle-Ottawa Scale.All analyses were performed using Review Manager 5.4.1.Result:A total of 11 studies with 3154 samples included in this study.There is no significant difference in 30-day mortality between the two groups(p-value=0.10).However,there is significantly less complication(RR 0.53[0.35,0.82];p-value=0.004)and unplanned intervention(RR 0.59[0.38,0.92];p-value=0.02)in the AD stent group.Comparison of the Nakata index showed no significant difference(p-value=0.88).Post-operative oxygen saturation was measured signifi-cantly higher in the AD stenting(MD 1.80[0.85,2.74];p-value=0.0002).However,AD stent group shows sig-nificantly lower long-term oxygen saturation(MD-8.43[-14.38,-2.48];p-value=0.005).Both hospital and ICU length of stay was significantly shorter in the AD stent group(MD-8.30[-11.13,-5.48];p-value<0.00001;MD-5.09[-7.79,-2.38];p-value=0.0002).Conclusion:AD stenting provides comparable outcomes relative to MBTS as it provides less complication and unplanned intervention and higher post-procedural O2 saturation.However,MBTS proved its superiority in maintaining higher long-term oxygen saturation and still became the preferred option to manage complex cases where stenting is either challenging or unsuccessful.

Effect of Simulated Microgravity and its Associated Mechanism on Pulmonary Circulation in Rats

Objective To study the effect of Simulated Microgravity and its Associated Mechanism on Pulmonary Circulation in Rats. Methods Rat tail-suspension model was used to simulate the physiological effects of microgravity and changes in pulmonary blood vessel morphology, pulmonary arterial and venous blood pressure, pulmonary vascular resistance, pulmonary vasomotoricity, as well as the regulation of pulmonary circulation by cytokines produced and released by the lung of rats were measured. Results The walls of pulmonary blood vessels of rats were thickened, and the pulmonary artery was reconstructed with increased pulmonary vascular resistance. The pulmonary blood vessels of rats became more prone to dilation as contractions increased. Rat epithelial Adrenomedulin gene transcription and protein expression were upregulated. The level of basic fibroblast growth Factor of rat was also elevated. Conclusion Findings from the present study on rats revealed that the microgravity can affect pulmonary blood vessel structure, pulmonary arterial pressure, and pulmonary blood vessel self-regulation and cytokine production.

Application Effect of External Diaphragm Pacemaker Combined with Active Respiratory Circulation Technology in Pulmonary Rehabilitation of Perioperative Lung Cancer Patients

Aim: To explore the application effect of external diaphragm pacemaker combined with active respiratory circulation technology in pulmonary rehabilitation of perioperative lung cancer patients. Methods: A total of 98 lung cancer patients admitted to our hospital from April 2020 to November 2021 were selected as the observation objects, and then divided into a control group and an observation group using the random number table method, with 49 cases in each group. The control group received routine admission guidance and active respiratory circulation training, while the observation group was supplemented with external diaphragm pacemaker on the basis of the control group. The intervention effect was evaluated by blood gas indicators, pulmonary function indicators, diaphragm function indicators, sputum comfort degree, and activity tolerance indicators before and after intervention. Results: Before intervention, there were no significant differences in blood gas analysis indicators, pulmonary function indicators, diaphragm function indicators, sputum comfort degree, and activity tolerance indicators between the two groups (P > 0.05). After intervention, the improvement degree of the above indicators in the observation group was higher than that in the control group (P < 0.05). Conclusions: The application of external diaphragm pacemaker combined with active respiratory circulation technology in pulmonary rehabilitation of perioperative lung cancer patients is significant, which can effectively improve the pulmonary function, blood gas function, and diaphragm function of lung cancer patients after surgery, and improve the activities of daily living and quality of life of patients.

Hypoxia in the pulmonary vein increases pulmonary vascular resistance independently of oxygen in the pulmonary artery

Introduction:Hypoxic pulmonary vasoconstriction(HPV)can be a challenging clinical problem.It is not fully elucidated where in the circulation the regulation of resistance takes place.It is often referred to as if it is in the arteries,but we hypothesized that it is in the venous side of the pulmonary circulation.Methods:In an open thorax model,pigs were treated with a veno-venous extra corporeal membrane oxygenator to either oxygenate or deoxygenate blood passing through the pulmonary vessels.At the same time the lungs were ventilated with extreme variations of inspired air from 5%to 100%oxygen,making it possible to make combinations of high and low oxygen content through the pulmonary circulation.A flow probe was inserted around the main pulmonary artery and catheters in the pulmonary artery and in the left atrium were used for pressure monitoring and blood tests.Under different combinations of oxygenation,pulmonary vascular resistance(PVR)was calculated.Results:With unchanged level of oxygen in the pulmonary artery and reduced inspired oxygen fraction lowering oxygen tension from 29 to 6.7 kPa in the pulmonary vein,PVR was doubled.With more extreme hypoxia PVR suddenly decreased.Combinations with low oxygenation in the pulmonary artery did not systematic influence PVR if there was enough oxygen in the inspired air and in the pulmonary veins.Discussion:The impact of hypoxia occurs from the alveolar level and forward with the blood flow.The experiments indicated that the regulation of PVR is mediated from the venous side.

一种用于CRRT/ECMO血路管的多功能可视固定装置的设计与应用

目的探讨一种用于连续性肾脏替代治疗/体外膜肺氧合(CRRT/ECMO)血路管的多功能可视固定装置在治疗过程中的应用效果。方法将2024年1月至5月进行连续性肾脏替代(CRRT)治疗和(或)体外膜肺氧合(ECMO)治疗的156例患者随机分为对照组和观察组,每组78例。对照组采用弹力绷带和胶布固定体外循环管路,观察组使用多功能可视固定装置对血路管进行固定,比较两组患者留置导管发生移位的例次、患者舒适度和医患满意度。结果观察组留置导管发生扭曲或移位、置管处有渗出、辅料污染需要更换发生率均低于对照组(P<0.05),观察组满意度及护士满意度均高于对照组。结论用于CRRT/ECMO血路管的多功能可视固定装置能提高管路固定效果,有效降低患者治疗过程中意外事件的发生率,提高患者舒适度和护患满意度,值得在临床推广应用。

Effects of Prostaglandins and Leukotrienes on Hypoxic Pulmonary Vasoconstriction in Rats

To investigate the effects of prostaglandins (PGs) and leukotrienes (LTs) on hypoxic pulmonary vasoconstriction (HPV), in vivo rats experiment and in vitro perfused lung experiment were conducted. The effect of hypoxia on hemodynamics, concentrations of TXB 2 and 6 keto PGF 1α in serum and lung tissue during hypoxia and effects of PGs and LTs on HPV were observed. The results showed that pulmonary arterial pressure (P pa ) and pulmonary vascular resistance were increased during hypoxia, but cardiac output and systemic arterial pressure were decreased. There were increases of the concentrations of TXB 2 and 6 keto PGF 1α and their ratio in serum and lung tissue during hypoxia. After use of cyclooxygenase inhibitor (indomethacin) in vivo and in vitro , HPV was augmented respectively, but after use of lipoxygenase inhibitor (diethylcorbamazine) or leukotriene receptor blocker (LY 171883), HPV was attenuated. It was suggested that LTs mediated pulmonary vasoconstriction, PGs inhibited pulmonary vasoconstriction and they played a modulating role during hypoxia.

活血化瘀法中药复方治疗慢性阻塞性肺疾病合并肺动脉高压疗效及安全性的Meta分析

目的系统评价活血化瘀法中药复方治疗慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)合并肺动脉高压(Pulmonary hypertension,PH)的有效性及安全性。方法计算机检索CNKI、Wanfang Data、VIP Database、CBM、PubMed、Web of science、Embase、Cochrane Library中英文数据库自建库至2023年4月30日期间,活血化瘀法治疗COPD合并PH的随机对照试验,并提取数据,采用Revman 5.3软件进行Meta分析与系统评价,其安全性指标用不良反应发生率来评价。结果共纳入文献42篇,涉及患者3558例,实验组活血化瘀法联合西医常规治疗组1794例,对照组西医常规治疗组1764例。Meta分析结果显示:与对照组比较,实验组提高临床有效率[RR=1.26,95%CI(1.21,1.31),P<0.0001];改善患者缺氧、二氧化碳潴留:血氧分压(Arterial partial pressure of oxygen,PaO_(2))[SMD=0.92,95%CI(0.60,1.24),P<0.0001]、二氧化碳分压(Arterial partial pressure of carbon dioxide,PaCO_(2))[SMD=-0.97,95%CI(-1.41,-0.52),P<0.0001]、动脉血氧饱和度(Arterial oxygen saturation,SaO_(2))[MD=2.36,95%CI(0.92,3.80),P=0.001];降低肺循环压力:肺动脉收缩压(Pulmonary artery systolic pressure,PASP)[MD=-4.55,95%CI(-5.60,-3.51),P<0.0001];改善临床症状,提高运动耐量:6 min步行距离(6-minute walking distance,6MWD)[MD=51.00,95%CI(39.80,62.19),P<0.0001]、证候总评分[MD=-2.91,95%CI(-3.52,-2.31),P<0.0001]、改良英国医学研究委员会呼吸困难量表(Modified British medical research council dyspnea scores,mMRC)评分[MD=-0.82,95%CI(-0.89,-0.76),P<0.0001]和慢阻肺患者自我评估测试(COPD assessment test,CAT)问卷[MD=-6.49,95%CI(-12.74,-0.25),P=0.04];提高血清一氧化氮(Nitric oxide,NO)[SMD=0.83,95%CI(0.35,1.32),P=0.0007]等方面有优势;但在不良反应发生率方面无显著差异[RR=1.50,95%CI(0.44,5.11),P=0.52]。结论活血化瘀法中药复方联合西医常规治疗COPD合并PH具有较好的临床疗效,能显著提高临床有效率、改善患者缺氧、二氧化碳潴留,改善临床症状,提高运动耐量,降低肺循环压力等。但在安全性方面尚待进一步研究,未来仍需更多严谨高质量RCT研究来验证。

Effects of 3，4－Dihydroxyacetophenone （3，4－DHAP） on Hypoxic Pulmonary and Systemic Vascular Response in Dogs

The effects of 3,4-DHAP on hypoxic pulmonary and systemic vascular responses were studied in anaesthetized dogs. The percentage change in pulmonary vascular resistance(△PVR%)and that in systemic vascular resistance(△SVR%)induced by 5 min hypoxia decreased significantly.3,4-DHAP in doses of 1 mg/kg,3mg/kg,and 10 mg/kg i.v caused a decrease in b PVR% from the control value of 47.27±22.27% to 24.62±21.76%,18.15±18.73%,and 24.10±19.76% respectively, and a decrease in △SVR% from the control value of 12.91±7.39% to -0.34±12.7%,-2.11±12.76%,and -2.37±15.52% respectively.The results showed that 3,4-DHAP could decrease the hypoxic responses of pulmonary and systemic blood vessels.But it did not change △PVR% or △SVR% in dose of 30mg/kg,neither did it influence the heart rate,cardiac output or cerebral blood flow during hypoxia in all the doses used.

地塞米松预充对小儿心脏手术肺氧合功能的影响

目的观察体外循环体外循环(CPB)预充液中应用地塞米松对小儿心脏手术肺氧合功能的影响,为临床实践提供相应的依据。方法选取2023年2月至2024年1月贵阳市妇幼保健院心脏中心收治的行室间隔缺损修补术和(或)房间隔缺损修补术的先天性心脏病(CHD)患儿54例作为研究对象,随机将其分为对照组和地塞米松组,每组27例。对照组未给予地塞米松治疗,地塞米松组预充液中加入5 mg/kg地塞米松,分别于麻醉诱导后CPB前(T_(0))、CPB 15 min(T_(1))、主动脉开放前5 min(T_(2))、CPB结束时(T_(3))、入重症监护室(ICU)后2 h(T_(4))取血样进行动脉血气分析,计算呼吸指数(RI)、氧合指数(OI)、动脉肺泡氧分压比值(PaO_(2)/PAO_(2),a/A),记录术前一般状况及围手术期参数。结果对照组RI指标在T_(2)时点为2.52±2.57,显著高于地塞米松组(1.39±1.42),差异有统计学意义(P<0.05);2组患者OI、a/A指标比较,差异均无统计学意义(P>0.05)。术后气管拔管率及ICU机械通气时间比较,差异均无统计学意义(P>0.05)。结论CPB预充液中给予地塞米松可在一定程度上在一定时间段内改善CPB后肺氧合功能。

静脉动脉-体外膜肺氧合在肺动脉高压治疗中的研究进展

静脉动脉-体外膜肺氧合(VA-ECMO)是一项用于治疗严重心肺功能障碍患者的体外循环技术。它通过模拟心肺功能,提升血氧水平,减轻心脏负荷,在处理肺动脉高压方面发挥着重要作用。作为一种临时生命支持手段,可对心肺功能衰竭的肺动脉高压患者进行短期治疗,延长治疗时间,推动病情好转,为肺血管修复和重建提供契机。VA-ECMO在不同类型的肺动脉高压中均扮演着重要角色,有助于挽救患者生命,减少永久性心肺功能损伤。现对VA-ECMO在肺动脉高压治疗方面的研究进展进行综述。

肺动脉闭锁根治及体肺侧支融合患儿的术后护理

总结1例行肺动脉闭锁根治及体肺侧支融合患儿的术后护理体会。针对患儿手术操作复杂、体外循环时间长、术后右心室顺应性差、应用人工带瓣血管、延迟关胸等问题,采取严格控制出入量,维持右心功能稳定;做好早期动态抗凝管理,保持人工带瓣血管通畅;重视延迟关胸及呼吸道护理;加强营养支持及心理护理等措施。经过精心治疗和护理,患儿康复出院。随访6个月,患儿右室流出道通畅,心功能恢复良好。

基于“肝肺气血循环轴”探析肺结节治疗思路

罗胜教授认为,肝肺之间存在以气机为基础、气血经脉循环流注的综合轴,即“肝肺气血循环轴”,并提出肺结节的关键病机是肝主疏泄失职,气机血运失调。肝失疏泄,肺气受损,肝肺气机升降平衡失调,气血津液阻滞于肺络,导致气郁痰凝血瘀等病理因素产生,最终形成肺结节。基于肝肺气血循环轴,提倡疏肝理肺法,兼顾祛瘀化痰,扶正固本。附验案一则,为治疗肺结节提供思路。

肺结节术后咳嗽探析:基于“一气周流”理论

基于黄元御“一气周流”理论探析肺结节术后咳嗽的治疗,认为中轴失调、脾胃自损是肺结节术后咳嗽发生之根源,同时伴随的肝郁左升无力、肺虚右降无权加重气机滞塞是肺结节术后咳嗽发生发展的关键。故临证之时重视调理中土升降之轴,佐以疏肝补肺调畅左右之路,构成以中气健运为轴、左路肝木升发调达、右路肺金自然敛降的气机循环流转,多脏同治,进而治愈此病。总结“一气周流”理论,以期为肺结节术后咳嗽的临床治疗及用药提供参考。

Factors Accounting for Different Responses of Pulmonary and Cerebral Vessels to Hypoxia

The roles of sympathicus, sensory neuropeptides (SNP),cyclooxygenase metabolites (COX-M), lipoxygenase metabolites (LOX-M), endothelium derived relaxing factor (EDRF),reactive oxygen (ROS) and potassium channels (PC) in the hypoxic pulmonary vasoconstriction (HPV) and hypoxic cerebral vasodilation (HCVD) were investigated in intact rats, rabbits and dogs. The results showed that during hypoxia,the excitation of sympathicus caused a constriction of both pulmonary and cerebral vessels,while SNP, EDRF and the opening of voltage sensitive PC caused the dilation of both of them; LOX-M mediated HPV and HCVD, COX-M might serve as their modulators; the blockade of ATP sensitive PC induced by hypoxia mediated HPV, but had no effect on HCVD; the reduction of O_2￣- in the lung might potentiate HPV, however, O_2￣- remained unchanged in brain during hypoxia. It is suggested that the alterations of LOX-M,ROS and the ATP sensitive PC are the factors accounting for the difference in the response of pulmonary and cerebral vessels to hypoxia.

主动呼吸循环技术联合多频排痰在高龄稳定期慢性阻塞性肺疾病中的临床观察

目的:探讨主动呼吸循环技术联合多频排痰在高龄稳定期慢性阻塞性肺疾病(COPD)患者中的临床效果。方法:选取上海市金山区众仁老年护理医院2022年3月~2023年12月收治的86例高龄稳定期COPD患者,按随机数字表法分为两组,各43例,常规组采用常规护理及多频排痰治疗,研究组在常规组的基础上指导主动呼吸循环技术,对比两组干预效果。结果:治疗前,组间肺功能指标比较,差异无统计学意义(P>0.05),治疗后,两组1秒用力呼气量(FEV1)、用力肺活量(FVC)、第一秒用力呼气量占所有呼气量的比例(FEV1/FVC)水平有所上升,且研究组高于常规组,差异有统计学意义(P<0.05)。治疗前,组间COPD评估测试(CAT)量表评分、改良呼吸困难指数(MMRC)评分比较,差异无统计学意义(P>0.05),治疗后,两组CAT评分、MMRC评分有所下降,且研究组低于常规组,差异有统计学意义(P<0.05)。结论:对高龄稳定期COPD患者采取主动呼吸循环技术联合多频排痰疗效显著,可改善患者呼吸状况、肺功能和运动耐力,提高患者生活日常生活能力。

ACBT方案联合渐进弹力抗阻运动对老年肌少症合并慢性阻塞性肺疾病患者肺功能、动脉血气及运动耐力的影响

目的探讨主动呼吸循环技术(ACBT)方案联合渐进弹力抗阻运动在老年肌少症合并慢性阻塞性肺疾病(简称慢阻肺)干预中的应用价值。方法选取2018年5月至2023年1月在首都医科大学石景山教学医院干预治疗的104例老年肌少症合并慢阻肺患者作为研究对象,采用信封法将患者分为观察组和对照组,每组52例。对照组给予渐进弹力抗阻运动干预,观察组给予ACBT方案联合渐进弹力抗阻运动干预,比较两组干预前后肺功能、动脉血气及运动耐力指标的差异。结果观察组干预后第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、FEV_(1)/FVC、FEV_(1)占预计值百分比、每分钟最大通气量占预计值百分比和呼气峰值流速均明显高于对照组(P<0.05)。观察组干预后动脉血氧分压和动脉血氧饱和度均明显高于对照组(P<0.05),而动脉血二氧化碳分压低于对照组(P<0.05)。观察组干预后6 min步行试验距离和Berg平衡量表评分均明显高于对照组(P<0.05)。观察组干预后总肌肉量、骨骼肌指数和握力均明显高于对照组(P<0.05)。观察组干预后日常生活能力量表评分高于对照组(P<0.05)。结论ACBT方案联合渐进弹力抗阻运动能明显改善老年肌少症合并慢阻肺患者肺功能、动脉血气及运动耐力指标,值得临床推广使用。

陈中沛从“三隧”“九窍”治疗肺结节经验

陈中沛主任认为,人有“三隧”,体有“九窍”,“三隧”即元气之隧、津液之隧、糟粕之隧,“九窍”是一种既宏观又微观的孔窍及门户结构,人体之腧穴、玄府、腠理、膜原等皆属于“九窍”。基于上述观点,陈主任提出元气虚弱是肺结节形成的先决条件,上焦元气之隧与津液之隧不利是肺结节的核心病机,痰瘀互结和窍闭络阻是肺结节的致病特点。治疗方面,当以补益元气与调畅两隧为主,辅以化痰散结、行瘀开窍,标本兼顾,可明显缩小或消除肺结节。附验案1则。

Interventional treatment of pulmonary arteriovenous malformations

Pulmonary arteriovenous malformations(PAVM) are congenital vascular communications in the lungs.They act as right to left shunts so that the blood running through these malformations is not oxygenated or filtered.These patients are typically hypoxaemic with exercise intolerance and are at high risk of paradoxical emboli to the brain and other organs.These malformations are most commonly seen in hereditary haemorrhagic telangiectasia(HHT)(Mb.Osler-Weber-Rendu syndrome).Nowadays,the generally accepted treatment strategy of first choice is embolization of the afferent arteries to the arteriovenous malformations.It is a minimally invasive procedure and at the same time a lung preserving treatment with a very high technical success,high effectiveness and low morbidity and mortality.Embolization prevents cerebral stroke and abscess as well as pulmonary haemorrhage and further raises the functional level.Embolization is a well-established method of treating PAVM,with a significant effect on oxygenation of the blood.Screening for PAVM in patients at risk is recommended,especially in patients with HHT.

Assessment of Reversibility in Pulmonary Hypertension Related to Congenital Heart Disease by Using Biomarkers and Clinical Features

Background:Reversibility of pulmonary hypertension(PH)is closely related to the treatment options for and prognosis of children with congenital heart disease.Objective:We combined patient-specific clinical features including diagnosis,age and echocardiographic results,and biomarkers of pulmonary vascular dysfunction to explore the noninvasive methods that can be used to accurately evaluate the reversibility of pulmonary hypertension in congenital heart disease(PH-CHD).Methods:Based on the preoperative systolic pulmonary arterial pressure(sPAP),70 CHD patients were divided into normal,PH-CHD suspected,and confirmed groups.Additionally,biomarkers of circulating endothelial cells(CECs),endothelin-1(ET-1),and endothelial nitric oxide synthase(eNOS)were detected.Patients were categorized into reversible(RPH)and irreversible(IRPH)groups according to the sPAP 6 months after surgery.Risk stratification was performed according to the clinical features and biomarkers.Results:CECs and ET-1 levels in the confirmed group were significantly higher.eNOS was higher in the confirmed and suspected groups than that in the normal group.CECs in the IRPH group were significantly higher compared to the RPH group.No such intergroup differences were observed with respect to ET-1 and eNOS levels.The ROC curve showed that the risk stratification was of high diagnostic value to evaluate reversibility.Conclusion:The CECs,eNOS,and ET-1 were closely related with PH-CHD.CECs and risk stratification have high practical value in assessing the reversibility of PH-CHD.

Arrhythmic Risk in Paediatric Patients Undergoing Surgical Repair for Pulmonary Atresia with Intact Ventricular Septum

Introduction:While previous studies only focused on the arrhythmic risk associated with specific correction strategies,this study evaluates this risk in a large cohort of paediatric patients with all phenotypes of PA-IVS after surgical repair.Methods:In this single centre observational cohort study,we retrospectively evaluated 165 patients with a diagnosis of PA-IVS and we excluded those with an exclusively percutaneous treatment,patients lost or with insufficient follow-up and those affected by other arrhythmic syndromes.Surgical history and clinical outcomes were reviewed.Results:86 patients were included in the study(54 male[62.8%],mean age 16.4±6.1 years),with median follow-up from definitive repair of 12.8 years(6.4–18.9 years).They underwent three different final repairs:23 patients(26.7%)univentricular palliation,43(50%)biventricular correction,and 20(23.3%)one and a half ventricle correction.Thirteen patients(15%)developed arrhythmia:6 patients(all the subgroups)sinus node disfunction(SND);2(biventricular repair)premature ventricular complexes;2(one and a half ventricle repair)non-sustained ventricular tachycardia;1(biventricular repair)intra-atrial re-entrant tachycardia;1(one and a half ventricle repair)supraventricular tachyarrhythmia;1(biventricular repair)atrial fibrillation.Three patients with SND needed a pacemaker implantation.Only Fontan circulation showed an association with SND,while the other two groups heterogeneous types of arrhythmias.Conclusions:The low arrhythmic risk is related to surgical repair,it does not appear to be associated with native cardiomyopathy,and it appears to increase with length of follow up.Continuous follow-up in specialized centres is necessary to make an early diagnosis and to manage the potential haemodynamic impact at medium-long term.