单肺移植手术前后的供体肺保护

目的探讨肺移植手术前后供体肺保护的处理经验。方法回顾性分析了2003年1月至2006年8月本院施行的同种异体单肺移植手术9例,其中左侧3例,右侧6例。冷低钾肺保护液灌注移植肺,术后三联免疫抑制剂抗排斥,并分析术后的胸片评分、氧合指数及肺动脉压变化情况。结果供体肺缺血时间平均为(308.6±50.8)min。8例患者均成功脱离呼吸机并存活过围手术期(>30d),术后拔除气管插管时间平均(4.8±3.4)d,1例未能脱机并在术后22d死亡。结论肺保护需要在多个环节中加以控制,不同时期的保护侧重点不同。     

小个体供肺移植至大个体受体的犬肺移植手术

目的探讨小个体供肺移植至大个体受肺的犬肺移植手术方法。方法取健康杂种犬12只,分供受体两两配对,供体体质量与受体体质量相差超过25%,分别行:①切除受体左上、中肺(即尖叶和心叶)及植入供体左肺;②切除受体左下肺(即膈叶)及植入供体左肺;③切除受体左全肺及植入供体全肺的手术。测定各段手术操作时间及移植术后术后移植肺动、静脉血血气分析等指标。结果所有肺移植手术均成功,移植肺肺静脉血血气分析结果正常。结论小个体供肺移植至大个体受肺的犬肺移植手术方法可靠,近期效果满意的,可供临床应用时参考。     

CT三维重建技术在解剖性肺段切除中的应用

目的 探讨CT三维重建技术在解剖性肺段切除中的应用价值.方法 2020年3月至2021年3月期间共有36例肺结节患者在江门市中心医院行胸腔镜解剖性肺段切除术.术前患者均行胸部增强CT,通过CT三维重建软件mimics进行支气管、血管三维成像,显示肺段的解剖结构,决定术中需解剖和切断的肺段动脉、静脉、支气管,制定手术方案.术中根据三维重建解剖暴露目标肺段的动脉、静脉、支气管,验证三维重建的准确性.结果 所有患者均顺利完成手术;术中情况和术前规划基本相符;本组手术时间(87.7±27.9)min,手术出血量(53.3±11.2)ml,术后引流量(563.6±116.3)ml,胸管留置时间(2.9±1.4)d,术后住院时间(5.1±1.3)d,术后均未出现严重并发症及手术死亡.结论 术前CT三维重建技术能清楚显示肺段的解剖结构,对精准肺段切除有其应用价值.     

同种异体右肺移植手术准备与配合2例

目的探讨肺移植手术的准备、配合和护理.方法分析了我院两例肺移植手术过程中人员配备、物品准备、手术配合和术中护理等过程.结果手术配合和护理重点在:动物实验和术前讨论;现场供体肺处理;手术物品准备;术中药物使用时机和剂量;病人体温控制和输液速度调节;护士操作熟练和用物数目清晰 .结论制订必要的人员配备物品准备和手术配合及护理常规有助于肺移植手术的成功.     

肺移植患者的康复护理

目的探索肺移植患者术前后的康复护理.方法通过术前评估了解患者的综合状况进行分析,并针对问题做好患者心理康复护理,术前后康复护理和出院康复指导.结果医护紧密配合,3例患者顺利成功接受了移植手术,术后恢复良好,肺功能检查显示比术前明显改善.生活完全自理,已投入社会工作.结论 3例肺移植患者的康复过程,是护理思路和做法一个良好开始,康复过程存在的问题还需我们在实践中去解决和不断创新,使肺移植患者的生存质量不断提高.[关健词] 肺移植;护理;康复     

建立同种异体肺移植的手术配合管理模式

目的探讨同种异体肺移植手术配合的管理模式,促进手术顺利完成.方法首先建立肺移植护理管理架构,参与医疗的各项动物实验及手术方案的制订,指导专科护士紧密配合动物实验、物品准备、药物使用、手术配合步骤等.结果经过5例同种异体肺移植手术配合实践,各项管理模式初步形成,管理见效,手术时间逐例缩短.结论建立相应的管理模式为开展肺移植手术顺利完成提供保证.     

建立同种异体肺移植的手术配合管理模式

目的探讨同种异体肺移植手术配合的管理模式,促进手术顺利完成.方法首先建立肺移植护理管理架构,参与医疗的各项动物实验及手术方案的制订,指导专科护士紧密配合动物实验、物品准备、药物使用、手术配合步骤等.结果经过5例同种异体肺移植手术配合实践,各项管理模式初步形成,管理见效,手术时间逐例缩短.结论建立相应的管理模式为开展肺移植手术顺利完成提供保证.     

同种异体右肺移植手术准备与配合2例

目的：探讨肺移植手术的准备、配合和护理．方法：分析了我院两例肺移植手术过程中人员配备、物品准备、手术配合和术中护理等过程．结果：手术配合和护理重点在：动物实验和术前讨论；现场供体肺处理；手术物品准备；术中药物使用时机和剂量；病人体温控制和输液速度调节；护士操作熟练和用物数目清晰．结论：制订必要的人员配备物品准备和手术配合及护理常规有助于肺移植手术的成功．     

硝普钠在心肺移植中对肺的保护作用

心肺移植是治疗终末期心肺联合病变的一种有效方法。其中移植肺更易受损 ,因而移植肺保护的好坏是心肺移植成败的重要因素之一。我们通过改良后的Ｋａｎｅｋｏ兔异位心肺移植模型[1] 观察一氧化氮 (ＮＯ)供体硝普钠对供体肺的保护作用。1　材料和方法1 1　研究对象及术前处理 :健康青紫兰兔 ,体重 2 0～2 5ｋｇ ,随机分为实验组及对照组 ,每组 8对供、受体 ,各组之间体重差异无显著性。供、受体均用 3%戊巴比妥钠经耳缘静脉注射麻醉 (1ｍＬ/ｋｇ)。供、受体均为清洁手术。1 2　供体制备 :供体兔仰卧位 ,气管切开插管接呼吸机 ,2 1%Ｏ2 ,呼…     

单孔胸腔镜肺楔形切除术和单孔胸腔镜解剖性肺段切除术治疗早期肺癌的效果

目的 比较单孔胸腔镜肺楔形切除术和单孔胸腔镜解剖性肺段切除术治疗早期肺癌的临床效果。方法 回顾性分析我院收治的90例早期肺癌患者的临床资料,根据手术方式不同将患者分为楔形组(n=43,行单孔胸腔镜肺楔形切除术)和肺段组(n=47,行单孔胸腔镜解剖性肺段切除术)。比较2组患者手术相关指标及术后1 d、2 d、3 d的疼痛情况。记录2组患者术前及术后3个月第1秒用力呼气量(FEV1)、最大通气量(MVV)、用力肺活量(FVC)等肺功能相关指标。记录2组患者术后并发症发生情况及术后3年生存情况。结果 与肺段组相比,楔形组患者的手术时间、术后留管时间及术后住院时间更短,术中出血量、术后胸腔引流量更少,差异均有统计学意义(P<0.05)。楔形组患者术后1 d、2 d、3 d的疼痛VAS评分明显低于肺段组(P<0.05)。术后3个月,2组患者肺功能指标均较术前显著下降,但楔形组的肺功能指标均高于肺段组,差异均有统计学意义(P<0.05)。楔形组并发症总发生率低于肺段组(P<0.05)。术后随访8～36个月,2组患者术后3年总生存率比较差异无统计学意义(P>0.05)。...     

Telomerase activity and the risk of lung cancer

Telomerase play a key role in the maintenance of telomere length and chromosome integrity. We have evaluated the association between telomerase activity and the risk of lung cancer in peripheral blood. Telomerase activity in peripheral blood mononuclear cells was measured by a PCR-designed telomeric repeat amplification protocol in 63 lung cancer patients and 190 healthy controls that were matched for age, gender, and smoking status. Telomerase activity was significantly lower in the lung cancer patients than in controls (mean ± standard deviation; 1.32 ± 1.65 vs 2.60 ± 3.09, P < 1 × 10(-4)). When telomerase activity was categorized into quartiles based on telomerase activity in the controls, the risk of lung cancer increased as telomerase activity reduced (P(trend) = 1 × 10(-4)). Moreover, when the subjects were categorized based on the median value of telomerase activity, subjects with low telomerase activity were at a significantly increased risk of lung cancer compared to subjects with high telomerase activity (adjusted odds ratio = 3.05, 95% confidence interval = 1.60-5.82, P = 7 × 10(-4)). These findings suggest that telomerase activity may affect telomere maintenance, thereby contributing to susceptibility to lung cancer.     

缺血后处理对移植犬肺功能的影响

目的： 观察缺血后处理对移植犬肺的呼吸功能的影响。方法：随机选取12对比咯犬,组成供受体,进行异体左侧单肺移植术。随机分成2组,对照组：6对犬,进行供受体左侧异体单肺移植,不予缺血后处理的干预,按常规方式进行;缺血后处理组：6对犬,进行供受体左侧异体单肺移植,常规方式获取的供体犬肺植入后,再灌注早期实施3个周期的10 s再灌-10 s再阻断,总时程1 min的缺血后处理。肺移植术后0 h、1 h、2 h、4 h时点观察移植肺的血流动力学、气体交换功能;肺移植术后4 h肺湿／干重比;光镜下观察供体犬肺2 h、4 h时点肺组织的病理变化。结果：手术无1例失败,均存活。供体肺脏植入时间平均(5.9±1.7) min。与对照组比较,缺血后处理组的移植犬肺的平均肺动脉压(MPAP)和肺血管阻力指数(PVRI)降低,差异显著（P＜0.05）;而平均体循环血压(MSAP) 和体循环阻力指数(SVRI)无显著差异（P＞0.05）。气体交换方面与对照组比较,缺血后处理组的动脉血氧分压(PaO2)升高,肺泡-动脉血氧分压差（PA-aO2）及肺内动静脉分流(QS／QT)减低,差异显著（P＜0.05）;而动脉血二氧化碳分压（PaCO2）无显著差异（P＞0.05）。缺血后处理组的移植犬肺湿／干重比与对照组比较,差异显著（P＜0.05）。组织光镜下观察在各时点的炎症反应均比对照组的变化轻微。结论：缺血后处理可以减轻供体肺的缺血再灌注损伤,改善供体肺功能。     

Postnatal growth of lung parenchyma in the piglet: Morphometry correlated with mechanics

Background: A previous study of piglet lung growth (Mansell et. al. 1989. J. Appl. Physiol., 67:1422–1427) showed transient stiffness to changes in shape and volume immediately after birth. Later, elastic recoil was found to increase as the lung grew in weight and volume. The present study uses morphometry to test possible structural correlates of these two mechanical changes. Methods: Piglet lungs were fixed near full inflation via the airways during the immediate newborn period (6–12 hours, n=3), at 3–5 days (n=6), 25–30 days (n=5), and 80–85 days (n=3). Morphometry comprised arithmetic and harmonic mean thicknesses of alveolar septae and average mean surface curvature. Measurements of curvature and airspace volume were combined to differentiate alveolar expansion from septal proliferation as mechanisms for volumetric growth. Results: The unique mechanical behavior of the newborn lungs was associated with relatively thick alveolar septae. Marked thinning of the septae and resolution of the stiffness to shape and volume change had occurred by 3–5 days. An increase in elastic recoil during the first postnatal month was found to be associated with simple airspace expansion. The second and third months were characterized by septal proliferation and increase in arithmetic mean septal thickness but elastic recoil did not increase further. Harmonic mean septal thickness and airspace volume per gram of lung tissue did not change over the course of the study. Conclusions: 1) A relative stiffness to shape and volume change in freshly newborn piglet lung is associated with relatively thick alveolar septal walls; 2) postnatal development of piglet lung parenchyma involves septal lengthening and thinning followed by septal proliferation; 3) the initial phase of septal lengthening, rather than the later phase of septal proliferation, is associated with increase in parenchymal recoil. © 1995 Wiley-Liss, Inc.     

氧控制性再灌注抗犬体外循环肺缺血再灌注早期损伤过程中高迁移族蛋白1的表达

目的 探讨氧控制性再灌注抗犬体外循环肺缺血再灌注早期损伤过程中高迁移族蛋白1(HMGB1)的表达.方法 健康犬14只按完全随机法分为对照组(n=7)和实验组(n=7),均进行体外循环肺缺血再灌注.对照组全程吸入氧浓度(FiO2)80%;实验组在主动脉开放即刻调整FiO2至40%,随后每5 min依次上调10%,最后达80%,其余时段均维持FiO2 80%.观察2组犬在麻醉后、主动脉开放前、主动脉开放后5、10、15、20、25 min以及停机前动脉血氧分压(PaO2)的变化.在开胸后即刻(T1)、主动脉开放25 min(T2)、主动脉开放90min(T3)分别留取血液标本及肺组织标本,检测肺组织HMGB1及NF-κB的表达,酶联免疫吸附法(ELISA)检测血清IL-6和TNF-α含量;检测肺组织湿干质量比及肺组织髓过氧化物酶(MPO)活性、丙二醛(MDA)含量;观察肺组织病理学变化.结果 实验组PaO2在主动脉开放后5、10、15、20min均显著低于对照组(均P＜0.05).与对照组比较,在T2和T3时点实验组HMGB1 mRNA表达(T2:0.9260±0.013 9比1.0496±0.0306;T3:0.832 5±0.0154比0.9894±0.0144,均P＜0.05)和蛋白表达(T2:0.434 5±0.074 8比0.551 2±0.047 4;T3:0.449 0±0.054 1比0.545 5±0.040 6,均P＜0.05)均降低.实验组肺组织NF-κB蛋白表达在T2和T3时点低于对照组(均P＜0.05).实验组血清IL-6和TNF-α含量在T2和T3时点低于对照组(均P＜0.05).实验组肺组织湿干质量比、MPO活性、MDA含量在T2和T3时点均低于对照组(均P＜0.05).实验组肺损伤评分在T2和T3时点均低于对照组[T2:(2.0±0.7)分比(3.8±0.5)分;T3:(2.6±0.6)分比(4.2±0.8)分,均P＜0.05].结论 氧控制性再灌注对体外循环肺缺血再灌注早期损伤具有保护作用,其机制可能与下调HMGB1表达有关.     

c—Jun氨基末端激酶选择性抑制剂对哮喘小鼠肺组织IL-2表达的影响

目的探讨c-Jun氨基末端激酶选择性抑制剂（SP600125）对哮喘小鼠肺组织白介素-2（IL-2）表达的影响。方法30只BALB／c小鼠随机分为对照组、哮喘组和SP600125组，制作哮喘模型及干预处理后，处死小鼠，取肺组织，采用免疫组织化学方法和Western blot方法检测各组小鼠肺组织内IL-2的表达。结果免疫组化结果显示，哮喘组小鼠肺组织IL-2表达的平均光密度值为0．76＋0．11，显著高于对照组0．25±0．04，P〈0．01；而SP600125组小鼠肺组织IL-2表达的平均光密度值为0．45±0．08，与哮喘组相比明显降低，P〈0．01。Westernblot结果显示，哮喘组小鼠肺组织IL-2表达的平均光密度值为1．26±0．21，显著高于对照组0．36±0．05，P〈0．01；而SP600125组小鼠肺组织IL-2表达的平均光密度值为0．88±0．11，与哮喘组相比明显降低，P〈0．01。结论c．Jun氨基末端激酶选择性抑制剂能降低哮喘小鼠肺组织IL-2的表达。     

Experience of International Air Transportation and Subsequent Lung Transplant in a Patient with COVID-19-associated Acute Respiratory Distress Syndrome: a Case Report

We report an inspiring case of a 55-year-old Korean female diagnosed with coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS) in Mexico. The patient was assessed for lung transplant as a salvage therapy for treatment-refractory ARDS following no signs of clinical improvement for > 7 weeks, despite best treatment. The patient was transported from Mexico to Korea by air ambulance under venovenous extracorporeal membrane oxygenation (ECMO) support. She was successfully bridged to lung transplant on day 88, 49 days after the initiation of ECMO support. ECMO was successfully weaned at the end of operation, and no bleeding or primary graft dysfunction was observed within the first 72 hours. The patient was liberated from mechanical ventilation on postoperative day 9 and transferred to the general ward 5 days later. Despite the high doses of immunosuppressants, there was no evidence of viral reactivation after transplant. At 3 months post-transplantation, she was discharged to home without complication. Our experience suggests that successful lung transplant for COVID-19-associated ARDS is feasible even in a patient with prolonged pre-transplant ECMO support. Lung transplant may be considered a salvage therapy for COVID-19-associated ARDS that does not respond to conventional treatments.     

Plasma proGRP concentration is sensitive and specific for discriminating small cell lung cancer from nonmalignant conditions or non-small cell lung cancer

To date, most clinical data on pro-gastrin-releasing peptide (proGRP) have been based on serum concentrations. This study evaluated the agreement between proGRP levels in fresh serum and plasma in patients with various lung diseases. Pairs of serum and EDTA plasma were collected from 49 healthy individuals. At the same time, EDTA plasma of 118 lung cancer patients and 23 patients with benign pulmonary diseases were prospectively collected. Compared to serum, plasma proGRP concentrations were higher by an average of 103.3%. Plasma proGRP was higher in malignancy (336.4 ± 925.4 pg/mL) than in benign conditions (40.1 ± 11.5 pg/mL). Small cell lung cancer (SCLC) patients showed higher levels of proGRP (1,256.3 ± 1,605.6 pg/mL) compared to other types of lung cancer. Based on the ROC curve analyses at a specificity of 95%, the diagnostic sensitivity of plasma proGRP was estimated to be 83.8% in distinguishing SCLC from all the other conditions, and 86.5% for discriminating SCLC from the nonmalignant cases. Among the SCLC cases, limited stage disease had lower levels of plasma proGRP than extensive disease. When measuring circulating levels of proGRP, the use of plasma is preferred over serum. Plasma proGRP has a potential marker for discriminating SCLC from nonmalignant conditions or non-small cell lung cancer.     

EBNA1 expression in a lung transplant recipient with hypocomplementemic urticarial vasculitis syndrome

This article describes a transplant recipient with underlying hypocomplementemic urticarial vasculitis syndrome who expressed persistently Epstein-Barr virus nuclear antigen 1 (EBNA1) in peripheral blood. The patient received a bilateral lung transplant and was subsequently followed with monitoring of EBV expression in peripheral blood. Evaluation of viral expression in peripheral blood, serum, and graft tissue was performed with RT-PCR, Q-PCR, indirect immunofluorescence, anti-peptide assays, and in situ hybridization; samples were collected at various time-points up to 91 days post-transplantation. The patient expressed EBNA1 in 8/10 (80%) of the peripheral blood samples tested during the post-transplantation period, and interestingly, even including the day of transplantation. After analyses of indicative EBV mRNA, EBNA1 expression was found mainly to be Qp-initiated EBNA1, known to be important for EBV maintenance. Anti-EBNA1 epitope mapping showed significantly higher and broader antibody responses to EBNA1 epitopes pre-transplantation when compared to normal controls and a matched lung transplant control. Post-transplantation this response was largely diminished but there were still epitopes significantly higher than controls. Our results show the presence of EBV-positive proliferating cells before onset of intensive immunosuppressive treatment. Although no previous connection between EBV and hypocomplementemic urticarial vasculitis syndrome has been reported, it is tempting to speculate that the continuous EBNA1 expression is not caused by immunosuppression or post-transplant lymphoproliferative disease, but may be a factor involved in the etiology of the autoimmune disease.     

肺癌螺旋断层放疗计划设计中应用Block减少肺低剂量区的研究

目的: 研究非小细胞肺癌螺旋断层放疗计划设计中应用Block降低肺低剂量区的方法。 方法:选取20例非小细胞肺癌病例,对每例病例勾画保护区域作为Block,并按以下3种不同的Block设置方式设计放疗计划。第I组采用Unblock方式,第II组采用Directional Block方式,第III组采用Complete Block+Directional Block方式。优化结果满足靶区和危及器官剂量限值后,比较3组方案计划靶区和肺组织剂量分布、剂量体积直方图（DVH）和单次治疗时间,用单向方差分析方法（One-Way ANOVA）对相关数据的差异性进行统计学分析。 结果:I到III组,双肺V5依次为（51.3±6.5）%、（37.4±5.0）%、（26.5±2.9）%,双肺平均剂量（MLD）依次为（10.4±0.5）%、（9.4±0.8）%、（8.2±1.0）%。将第II组和第III组分别与第I组进行比较,双肺V5分别降低了27%、48%,双肺MLD分别降低了9.6%、21%。V5和MLD明显降低,差异具有统计学意义。与此同时,PTV剂量均匀性变差,均匀性指数依次为0.065±0.003、0.082±0.006、0.084±0.011,差异具有统计学意义。PTV适形度指数依次为0.77±0.07、0.69±0.09、0.62±0.08,差异不具有统计学意义。I到III组的治疗时间依次为（5.5±0.5）、（11.8±0.6）、（16.3±2.3） min,第II组和第III组的治疗时间分别是第I组的2.1倍和2.9倍。 结论:非小细胞肺癌螺旋断层放疗计划设计时,运用Complete Block和Directional Block能够有效减少正常肺组织V5的体积,同时可以降低MLD,但靶区的均匀性和适形性会受一定影响（仍符合临床要求）,治疗时间也会相应变长。     

Hospital Length of Stay in the First 100 Days after Allogeneic Hematopoietic Cell Transplantation for Acute Leukemia in Remission: Comparison among Alternative Graft Sources

Several studies have shown comparable survival outcomes with different graft sources, but the relative resource needs of hematopoietic cell transplantation (HCT) by graft source have not been well studied. We compared total hospital length of stay in the first 100 days after HCT in 1577 patients with acute leukemia in remission who underwent HCT with an umbilical cord blood (UCB), matched unrelated donor (MUD), or mismatched unrelated donor (MMUD) graft between 2008 and 2011. To ensure a relatively homogenous study population, the analysis was limited to patients with acute myelogenous leukemia and acute lymphoblastic leukemia in first or second complete remission who underwent HCT in the United States. To account for early deaths, we compared the number of days alive and out of the hospital in the first 100 days post-transplantation. For children who received myeloablative conditioning, the median time alive and out of the hospital in the first 100 days was 50 days for single UCB recipients, 54 days for double UCB recipients, and 60 days for MUD bone marrow (BM) recipients. In multivariate analysis, use of UCB was significantly associated with fewer days alive and out of the hospital compared with MUD BM. For adults who received myeloablative conditioning, the median time alive and out of the hospital in first 100 days was 52 days for single UCB recipients, 55 days for double UCB recipients, 69 days for MUD BM recipients, 75 days for MUD peripheral blood stem cell (PBSC) recipients, 63 days for MMUD BM recipients, and 67 days for MMUD PBSC recipients. In multivariate analysis, UCB and MMUD BM recipients had fewer days alive and out of the hospital compared with recipients of other graft sources. For adults who received a reduced-intensity preparative regimen, the median time alive and out of the hospital during the first 100 days was 65 days for single UCB recipients, 63 days for double UCB recipients, 79 days for MUD PBSC recipients, and 79 days for MMUD PBSC recipients. Similar to the other 2 groups, receipt of UCB was associated with a fewer days alive and out of the hospital. In conclusion, length of stay in the first 100 days post-transplantation varies by graft source and is longer for UCB HCT recipients. These data provide insight into the resource needs of patients who undergo HCT with these various graft sources.