肝移植术后急性肺损伤/急性呼吸窘迫综合征的研究进展

急性肺损伤/急性呼吸窘迫综合症（ALI/ARDS）是肝移植术后常见的并发症,可延长受者术后重症监护室入住时间,影响肝移植手术疗效,病情严重可致受者死亡,临床中引起了肝移植外科医师的高度重视。肝移植术后ALI/ARDS可由肺源性因素（例如机械通气相关肺损伤、肺部感染、误吸等）直接导致,也可由非肺源性因素（例如肺部以外的严重感染、输血、缺血-再灌注损伤等）间接导致。本文对肝移植术后ALI/ARDS的诊断标准及发生情况、发生机制、危险因素、实验室及临床诊断方法以及治疗方法等进行综述,加深对肝移植围手术期ALI/ARDS的理解与认知,以期为肝移植术后ALI/ARDS的诊治提供借鉴。     

肝移植术后急性肺损伤的危险因素分析

目的 总结62例肝移植患者的临床资料，回顾性分析术后急性肺损伤（acute lung injury，ALI）发生的危险因素。方法 按ALI的诊断标准，将62例患者分为急性肺损伤组（ALI组）和非急性肺损伤组（NO—ALI组），比较两组的年龄、性别、原发病因、手术方式及预后。单因素、Logistic回归分析肝移植术后ALI发生的危险因素。结果 两组患者年龄、性别、原发病因及手术方式无明显差别。12例ALI发生在术后1d至4周，3例死亡。单因素分析发现，术后肺部感染、术中及术后的门肺高压、术中输血量、术中补液量、术后再次开腹、术后急性肾功能衰竭、术后激素冲击治疗对ALI的发生有显著影响。回归分析提示，术后肺部感染、术中及术后的门肺高压是ALI发生的危险因素。结论 术后肺部感染、术中及术后的门肺高压是肝移植术后ALI发生的危险因素，重视上述因素对预防与减少ALI的发生具有较重要的临床意义。     

肝移植围手术期肺部并发症的危险因素及相关防治

背景 肝移植围手术期各类肺部并发症发生率高,发病机制复杂,严重影响患者的预后.目的 分析肝移植围手术期肺部并发症的危险因素并提出具体防治措施以保护肺功能.内容 介绍肝移植术后急性肺损伤(acute lung injury,ALI)的机理；患者术前病理生理因素、麻醉因素以及非特异性因素与肺部并发症的关系；围手术期肺功能保护的措施.趋向 对相关机制和危险因素进行深入研究,并采取相应防治措施,有助于减少肝移植患者围手术期肺部并发症的发生.     

肝移植术后急性肺损伤的危险因素

目的研究肝移植术后发生急性肺损伤（Acute lung injury，ALI）的危险因素。方法回顾性分析100例终末期肝病患者肝移植术后的临床资料。进行单因素及多因素回归分析肝移植术后发生ALI的危险因素。结果13例患者（13％，13／100例）被诊断为肝移植术后ALI。logistic回归分析显示术中大量输血（输血量超过5000ml）和严重的再灌注损伤（血清丙氨酸转氨酶超过600U／L）是肝移植术后急性肺损伤的独立危险因素。术中大量输血的患者发生ALI的危险增加12．7倍；严重的再灌注损伤发生ALI的危险增加7．0倍。结论大量输血和再灌注损伤是肝移植术后发生ALI的两个重要危险因素。ALI是肝移植术后严重的多因素并发症，有很高的死亡率。     

输血相关性急性肺损伤一例

输血相关性急性肺损伤(transfusion-related acute lung injury,TRALI)指发生在输血过程中或输血后6h内出现的缺氧或双侧肺水肿,排除左房高压,排除循环超负荷并且输血前没有预先存在的急性肺损伤.报道l例女性患者,36岁,全麻术中发生TRALI,经治疗后患者康复出院.     

肝移植术后急性肺损伤的观察与分析

目的 分析肝脏移植患者术后并发急性肺损伤(AU)的危险因素，并探讨其防治措施。方法 采用回顾性调查的方法，对4例肝脏移植患者的相关资料进行分析。结果 门肺高压症、呼吸机长期使用、严重感染、全身炎性反应综合征、高凝状态、液体超载、肾功能障碍等．是肝移植术后并发急性肺损伤及急性呼吸窘迫综合征(ARDS)的危险因素。结论 肝移植术后易发生ALI，预防并减少相关危险因素的影响．对减少术后ALI及ARDS有重要意义。     

肢体缺血/再灌注致急性肺损伤的研究现状

肢体缺血,再灌注是临床常见的一种病理生理过程,再灌注损伤不仅存在于局部缺血组织,尚可进一步引发远隔器官肺的损伤,现就肢体缺血/再灌注(limb ischemin-reperfusion,LIR)致急性肺损伤(acute lung injury,ALI)的病理生理机制和防治措施作一综述.     

肢体缺血/再灌注致急性肺损伤的研究现状

肢体缺血,再灌注是临床常见的一种病理生理过程,再灌注损伤不仅存在于局部缺血组织,尚可进一步引发远隔器官肺的损伤,现就肢体缺血/再灌注(limb ischemin-reperfusion,LIR)致急性肺损伤(acute lung injury,ALI)的病理生理机制和防治措施作一综述.     

肢体缺血/再灌注致急性肺损伤的研究现状

肢体缺血,再灌注是临床常见的一种病理生理过程,再灌注损伤不仅存在于局部缺血组织,尚可进一步引发远隔器官肺的损伤,现就肢体缺血/再灌注(limb ischemin-reperfusion,LIR)致急性肺损伤(acute lung injury,ALI)的病理生理机制和防治措施作一综述.     

肢体缺血/再灌注致急性肺损伤的研究现状

肢体缺血,再灌注是临床常见的一种病理生理过程,再灌注损伤不仅存在于局部缺血组织,尚可进一步引发远隔器官肺的损伤,现就肢体缺血/再灌注(limb ischemin-reperfusion,LIR)致急性肺损伤(acute lung injury,ALI)的病理生理机制和防治措施作一综述.     

肺切除术后急腹症

目的:探讨肺切除术后并发急腹症的诊断和治疗。方法:本组26例肺切除术后并发急腹症,其中腹部炎症4例,胃十二指肠溃疡出血、穿孔19例,麻痹性肠梗阻3例。胃穿孔行手术治疗1例,胃十二指肠出血经纤维胃镜止血4例。结果:肺切除术后并发急腹症发生率为0.24％,经治疗死亡7例。并发症死亡率26.9％。发生的可能原因与缺氧、手术范围、激素使用、腹部病史、术中通气量不足有关。诊断应根据早期症状、体征。结论:胸外科医师术后早期应注意患者的腹部症状、体征,如发生急腹症能及时诊断、治疗,可降低术后近期死亡率,提高手术安全度。     

Pulmonary complications following adult liver transplantation

PURPOSE: Pulmonary complications frequently occur after liver transplantation, but the risk factors associated with them have not been fully determined. We therefore sought to identify risk factors for pulmonary complications among adult liver transplant recipients. METHODS: We retrospectively reviewed the medical records of 128 consecutive adult patients who underwent 131 liver transplantations during 2001. We evaluated the incidence, time of onset, and outcome of radiographically determined pulmonary complications, as well as the factors predictive of infectious complications. RESULTS: Postoperative chest roentgenograms detected 68 cases of pulmonary complications, including pleural effusion (n = 50), atelectasis (n = 6), pneumonia (n = 6), pulmonary edema (n = 5), and acute respiratory distress syndrome associated with pneumonia (n = 1). Of the seven patients with pneumonia, five died. On univariate analysis the risk factors predictive for pneumonia were high serum creatinine and total bilirubin, hemodialysis at the time of occurrence, and history of acute rejection and on multivariate analysis increased total bilirubin and history of acute rejection. Pulmonary complications were dependent on the medical condition at the time of occurrence rather than on the preoperative condition. CONCLUSIONS: Although the incidence of pneumonia in liver recipients was relatively low, the mortality rate in patients who developed this complication was high. High-risk patients undergoing liver transplantation thus require early diagnosis and intensive treatment to diminish the morbidity and mortality associated with pulmonary complications.     

Hypotension,renal failure,and pulmonary complications in leptospirosis

During a recent outbreak of leptospirosis in northeastern Thailand, 148 patients with serologically diagnosed leptospirosis were seen in Loei hospital. The common serotypes were L. pyrogenes, and L. sejroe. Hypotension with a mean arterial pressure less than 70 mmHg upon admission or within 24 h after admission was observed in 94 patients or 64%. 30 patients had normal renal function; 30 patients had prerenal azotemia with mild pulmonary complication in 2; and 34 patients had acute renal failure. 29 patients with acute renal failure had pulmonary complications including pulmonary hemorrhage in 8, pulmonary edema in 3, acute respiratory distress syndrome (ARDS) in 14 and interstitial pneumonitis in 4. 54 patients had normal blood pressure. In this group 5 patients had acute renal failure; 16 had prerenal azotemia and 33 had normal renal function. Interstitial pneumonitis was noted in one patient with prerenal azotemia. Less renal complication and minimal pulmonary complication were seen in leptospirosis patients with normal blood pressure. The patients with normal renal function had no pulmonary complication. Good association existed between hypotension, renal failure and pulmonary complications.     

食管癌术后肺部并发症发生的原因及防治进展

食管癌在我国是一种高发的恶性肿瘤，其术后并发症的发生率非常高，以吻合口瘘尤为显著。随着手术技术的完善和手术器械的改进，目前吻合口瘘的发生已明显下降，而术后肺部并发症的发生逐渐增高，并逐步取代吻合口瘘，而上升为第1位。近年来，有关食管癌术后肺部并发症发生、发展的原因已有较多的研究成果，主要包括肺动脉血栓栓塞、肺不张和肺部感染及急性肺损伤，现就其发生的原因、防治方法进行综述。     

Starting hemoglobin value predicts early phase prognosis after liver transplantation

Few studies have addressed the relationship between starting hemoglobin (Hb) value and early phase prognosis after liver transplantation (OLT). The aim of our study was to determine the relationship between the starting Hb value and the early phase prognosis after OLT by retrospectively reviewing the medical records of 102 consecutive recipients. Within this cohort, 47 patients had pulmonary complications after OLT, including eight cases of pulmonary edema, 12 cases of acute lung injury, six cases of acute respiratory distress syndrome, and 21 cases of pneumonia. According to whether the patients had pulmonary complications or not, they were categorized into the “no” versus the pulmonary complication groups. Twenty-two perioperative variables were analyzed in both groups to screen for variables that affected early pulmonary complications. A starting Hb ≤100 g/L was an independent risk factor for postoperative pulmonary complications. The duration to initial passage of flatus and the intensive care unit length of stay were significantly prolonged in patients with starting Hb values ≤100 g/L; these patients had poorer arterial blood gas analyses. The starting Hb value predicted the early phase prognosis after OLT for cirrhosis-associated hepatocellular carcinoma.     

肺挫伤患者呼吸功能障碍的发病因素及治疗

目的:探讨导致肺挫伤患者呼吸功能障碍的发病因素,提高肺挫伤的治疗水平。方法:把影响肺挫伤患者呼吸功能的因素分为:外呼吸因紊,肺实质损伤,继发性病理因素影响。分析它们的特点,用于指导治疗252例肺挫伤患者并总结经验。结果:本资料ARDS发生率11.11％,死亡率6.35％均较文献报道低。结论:导致肺挫伤患者肺功能障碍病因复杂,合理应用病因分类有助于临床治疗。     

Successful therapy of severe pneumonia-associated ARDS after pneumonectomy with ECMO and steroids

Pneumonia and acute respiratory distress syndrome are life-threatening complications after pneumonectomy carrying high mortality. Because pulmonary reserve is inadequately low, an effective therapeutic strategy is needed to treat hypoxia. Extracorporeal membrane oxygenation is a highly effective method to reverse hypoxia in patients with acute respiratory distress syndrome, but has only once been described in a patient with postpneumonectomy pulmonary edema. We report a case of successful extracorporeal membrane oxygenation therapy in a patient with pneumonia-associated acute respiratory distress syndrome after pneumonectomy. Methylprednisolone therapy caused a dramatic improvement of pulmonary and systemic organ function.     

Pulmonary arteriopexy to prevent pulmonary artery kinking in orthotopic heart transplantation

Heart transplantation is still the best treatment for patients with end‐stage heart failure unresponsive to medical therapy or those treated with mechanical circulatory support. The surgical technique for heart transplantation is fraught with potential complications. One of these potential complications, kinking of the pulmonary artery after anastomosis of the recipient and donor pulmonary arteries, has been reported as a cause of acute right ventricular failure. We describe a technique to ensure proper configuration of the pulmonary artery after heart transplantation via a pulmonary arteriopexy to restore a physiologically appropriate angle of the great vessels.     

Pulmonary complications in acute hematogenic osteomyelitis in children]

An analysis of treatment in 49 patients has demonstrated that pulmonary complications aggravate the course of the disease and not infrequently are causes of lethal issues. It is considered that an early removal of the primary purulent focus by means of trephination and transosseous perfusion with antibiotic solutions in an acute stage provides for the prophylaxis of pulmonary complications and reduces the mortality.     

Pulmonary manifestations of the clinical syndrome of acute glomerulonephritis and lung hemorrhage

The pulmonary manifestations at the time of initial diagnosis were reviewed in 45 patients with the clinical syndrome of acute glomerulonephritis and lung hemorrhage. Initial pulmonary radiographic appearances encompassed a wide variety of abnormalities, and alveolar hemorrhage could not be reliably differentiated from other causes of pulmonary infiltration. The diseases underlying the syndrome included antiglomerular basement membrane (anti-GBM) disease (8/45), a systemic vasculitis (25/45), and idiopathic glomerulonephritis with idiopathic lung hemorrhage (12/45). A variety of acute pulmonary complications were seen, the most common being acute respiratory failure (13/45). Mortality directly due to pulmonary disease was uncommon (3/45 died from fulminant lung hemorrhage). Most deaths were from extrapulmonary manifestations of the underlying disease or infection. Follow-up studies in 22 patients 6 months after initial presentation indicated that although respiratory symptoms (3/22) or pulmonary radiologic abnormalities (5/22) were uncommon, the majority of patients had residual abnormalities on pulmonary function testing (16/22). Thus, the syndrome of alveolar hemorrhage with nephritis is associated with several distinct categories of underlying disease process. The initial chest radiograph is of limited value in differential diagnosis. Although a variety of acute and chronic respiratory complications may be anticipated and contribute significantly to morbidity, mortality is predominantly due to extrapulmonary progression of disease or infection complicating immunosuppressive therapy.