单肺通气与非通气侧肺不同给氧方式对开胸食管手术病人肺内分流的影响

双腔管可以使左右肺分开以保护健侧肺,且健侧肺通气与麻醉[以下简称单肺麻醉(OLV)]保持术野安静,故而给开胸手术带来极大方便,但由于非通气侧肺仍被灌注,分流率(Qs/Qt)增加,结果导致动脉血氧分压降低。本研究探讨单肺麻醉时非通气侧肺高频喷射通气(HFJV)和持续气流吹氧对Qs/Qt的影响,探讨胸外科麻醉预防低氧血症的最佳通气方法,以保障病人的安全。     

术侧肺部分通气法与单肺通气的比较研究

目的 与单肺通气(one-lung ventilation,OLV)比较术侧肺部分通气(partial ventilation of independent lung,PLV)情况下的氧合与气道压力.方法 16例接受食道手术的患者随机分为两组,进行自身对照交叉研究.在双肺通气后按不同顺序接受OLV和术侧肺PLV,比较3种通气时氧合指数(oxygen index,OI)及气道压力的变化.结果 两种通气方式下OI均显著低于双肺通气(two-lung ventilation,TLV),但PLV时显著高于OLV(PLV391±112,OLV134±53,TLV530±92,P<0.05);气道压力值在PLV时也显著低于OLV[Ppeak:(19±3)cm H2O vs(27±5)cm H2O,Pplat:(17±2)cm H2O vs(23±3)cm H2O,P<0.05](1 cm H2O=0.098 kPa). 结论PLV显著改善了氧合和呼吸力学指标.     

术侧肺部分通气法与单肺通气的比较研究

Objective The purpose of this study was to compare oxygenation and airway pressure during partial ventilation of the independent lung( PLV) with one-lung ventilation(OLV). Methods 16 patients undergoing thoracotomy for esophageal carcinoma were randomized divided into two groups and a self -controlled cross -over study was used. Two types of ventilation was used in different sequence after two-lung ventilation(TLV), oxygenation index( OI) and airway pressure was compared between groups. Results OI was significantly lower during OLV and PLV than TLV, while it was significantly higher during PLV than OLV (PLV391±112, OLV134±53, TLV530±92,P<0.05). Airway pressure was also significantly lower during PLV than OLV[Ppeak: (19±3) cm H20 vs(27±5) cm H2O,Pplat: (17±2) cm H2O vs (23±3) cm H20, P<0.05 ]. Conclusion PLV significantly improve oxygenation and respiratory mechanics.     

术侧肺部分通气法与单肺通气的比较研究

Objective The purpose of this study was to compare oxygenation and airway pressure during partial ventilation of the independent lung( PLV) with one-lung ventilation(OLV). Methods 16 patients undergoing thoracotomy for esophageal carcinoma were randomized divided into two groups and a self -controlled cross -over study was used. Two types of ventilation was used in different sequence after two-lung ventilation(TLV), oxygenation index( OI) and airway pressure was compared between groups. Results OI was significantly lower during OLV and PLV than TLV, while it was significantly higher during PLV than OLV (PLV391±112, OLV134±53, TLV530±92,P<0.05). Airway pressure was also significantly lower during PLV than OLV[Ppeak: (19±3) cm H20 vs(27±5) cm H2O,Pplat: (17±2) cm H2O vs (23±3) cm H20, P<0.05 ]. Conclusion PLV significantly improve oxygenation and respiratory mechanics.     

不同单肺通气模式对开胸手术患者血流动力学的影响

目的 评价不同单,肺通气模式对开胸手术患者血流动力学的影响.方法 选择拟行肺叶切除术或食道癌根治术的患者45例,年龄45～64岁,采用随机数字表法,将患者随机分为3组(n=15),间歇正压通气组(IPPV组);IPPV+呼气末正压组(IPPV+PEEP组):IPPV+5 cm H2O PEEP单肺通气30 min后,再行IPPV+10 cm H2O PEEP单肺通气30 min:IPPV+持续气道正压通气组(IPPV+CPAP组)通气侧肺采用IPPV模式,术侧肺加用5 cm H2OCPAP模式1h.于麻醉诱导前、气管插管后10 min、双肺通气30 min、单肺通气30 min、1h及术毕(T1-6)时记录MAP、HR,心排血量(CO)、心指数(CI)、每搏量(SV)和每搏指数(SVI).并于 T1,2,4-6时采集动脉血样行血气分析,记录血糖(Glu)和血乳酸(Lac)水平,计算氧供(DO2)及氧供指数(DO2I).结果 与IPPV组比较,IPPV+PEEP组T4,5时SV、SVI、CO、CI、DO2,DO2I降低(P＜0.05),Glu和Lac水平差异无统计学意义,IPPV+CPAP组上述各指标比较差异无统计学意义(P＞0.05).与IPPV+ PEEP组比较,IPPV+ CPAP组T4,5时SV、SVI、CO、CI、DO2、DO2I升高(P＜0.05),Glu和Lac水平差异无统计学意义(P＞0.05).结论 开胸手术患者通气侧肺采用IPPV模式,术侧肺加用5 cm H2O CPAP模式对患者血流动力学无明显影响,而通气侧肺IPPV+ PEEP模式虽然可导致血流动力学波动,但程度较小,可维持正常的机体氧供.     

单肺通气时无呼吸性气流通气对患者非通气侧肺泡巨噬细胞表型转化的影响

目的:评价单肺通气(OLV)时无呼吸性气流通气(AOI)对患者非通气侧肺泡巨噬细胞(AM)表型转化的影响。方法:选择择期行胸腔镜下肺叶切除术的患者60例,性别不限,年龄40~64岁,体重45~85 kg,采用电脑随机数字表法分为2组( n＝30)：观察组和对照组。OLV开始时观察组患者非通气侧肺给予3 L/...     

开胸手术时双肺两种不同通气方式可行性应用

开胸手术行健侧单肺通气,所出现的肺内分流和低氧血症,倍受人们关注.我院在开胸手术中采用健侧肺间歇正压通气(intermittent positive pressure ventilation,IPPV),患侧肺采用持续正压通气(continuous positive airway pressure,CPAP),收到满意疗效.     

单肺通气时气道压力的变化

本研究拟观测肺手术病人在仰卧位下 ,行双肺通气 (ＴＬＶ )和单肺通气(ＯＬＶ)时气道峰压的变化 ,旨在探讨其在判断双腔导管 (ＤＬＴ)位置的临床意义 ,为临床麻醉行ＤＬＴ时提供借鉴 ,现报告如下。资料和方法一、临床资料　选择痰量较少、肺功能正常、纤支镜检查阴性的择期肺手术病人 35例 ,男 2 1例 ,女 14例 ,年龄 45～75岁 ,体重 45～ 76ｋｇ ,ＡＳＡⅠ～Ⅱ级 ,无明显心血管及肝肾疾患 ,双腔导管(ＤＬＴ)型号分别为 35Ｆ(2例 )、37Ｆ(18例 )、39Ｆ(15例 )。其类型分别为Ｃａｒｌｅｎ(11例 )、Ｗｈｉｔｅ(5例 )、Ｒｏｂｅｒｓｈａｗ(19例 …     

1例双肺移植术后分侧肺通气患者的护理

总结1例双肺移植术后患者分侧肺通气的临床观察和护理。密切观察患者呼吸潮气量、呼吸频率、呼吸机波形及呼吸机报警,及早发现双腔气管移位,护理操作过程中有效防止气管导管移位,实施有效的气道管理,确保呼吸道通畅等。住院63d患者转出ICU,继续治疗至好转出院。     

单肺通气时气道压力变化及其临床意义的探讨

目的：观察双腔支气管导管（ＤＬＴ）插管后,由双肺通气（ＴＬＶ）改为单肺通气（ＯＬＶ）时气道压力变化,并探讨其在判断ＤＬＴ位置的意义。方法：造反纤支镜检查阴性、痰量较少、肺功能正常的肺手术病人３５例,依次行ＴＬＶ和ＯＬＶ（非手术侧）,并记录气道峰压、平台压,再行纤支镜检查。结果：（１）由ＴＬＶ改为ＯＬＶ后,ＤＬＴ位置异常（１０例）和正常时的气道峰压、平台压分别增加７４％、６７％和５２％、４５％;（２     

开胸术病人不同参数单肺通气的效果

目的评价开胸术病人不同参数单肺通气（OLV）的效果。方法择期行开胸术病人28例，ASAⅡ或Ⅲ级，麻醉诱导后双腔支气管插管，双肺通气（TLV）30min，设定潮气量（VT）为10ml／kg,呼吸频率（RR）12次／min。OLV时在保持分钟通气量不变的情况下，所有病人均先采用OLV1（VT10ml／kg，RR12次／min）30min，后改为OLV2（VT8ml／kg，RR15次／min）30min，最后改为OLV3（VT6ml／kg，RR20次／min）30min，分别于，ITLV前及OLV时每次调整VT后30min行动脉血气分析，同时监测气道峰压（Ppeak）、气道阻力（Raw）及血液动力学变化，计算每种通气方式的高气道压发生率。结果与TLV时比较，OLV时动脉血氧分压均明显下降，其中OLV3时动脉血二氧化碳分压上升（P〈0．01）；OLV时Ppeak及Raw均增高，其中OLV1时增高明显（P〈0．05）。OLV。时高气道压发生率达53．6％，高于OLV2及OLV3时（P〈0．01）。结论开胸术病人单肺通气时，VT8ml／kg及RR为15次／min通气效果较好。     

Incidence and prevalence of diabetes mellitus in patients with cystic fibrosis undergoing lung transplantation before and after lung transplantation

Cystic fibrosis (CF) related diabetes mellitus (DM) occurs in 15% of adult pancreatic insufficient CF patients. Lung transplantation is a treatment option for end-stage CF. We hypothesized that the prevalence of DM increases after lung transplantation. The study population included adult patients undergoing lung transplantation from March 1988 to March 2002 for end-stage CF at the University of Toronto. Demographic data, exocrine pancreatic function, presence of DM before and after transplant, as well as timing of its development after transplant were collected. Eighty-six patients met the study criteria; 77 of 86 (89.5%) of patients were pancreatic insufficient and were further analyzed. Median follow-up post-transplant was 3.3 yr (interquartile range: 1.2-7.2). Their mean age was 29.7 +/- 8.1 yr and 46 of 77 (59.7%) were male. The prevalence of DM increased from 22 of 77 (28.6%) before transplant to 38 of 77 (49.4%) after transplant (p = 0.008). The median time of DM development after transplant was 80 d (range: 13-4352). Sixteen of 55 (29.1%) of pancreatic insufficient patients who were non-diabetic prior to transplant, developed DM after transplant. DM is common in CF patients undergoing lung transplantation and the prevalence increases after transplant.     

Acute chest syndrome shows a predilection for basal lung regions on the side of upper abdominal surgery

PURPOSE: Upper abdominal surgery for cholecystectomy or splenectomy is the most frequently performed surgical procedure in patients with sickle cell disease (SCD). The acute chest syndrome (ACS) is the most common sickle-related postoperative complication. The objective of the study was to characterize the clinical and radiological presentation of ACS complicating cholecystectomy and splenectomy. METHODS: The medical records of all children with SCD undergoing cholecystectomy or splenectomy during the 15-year period from January 1988 through December 2002 were reviewed. Patients who experienced ACS within 14 days after surgery were identified. Data collected included demographics, perioperative management, clinical and radiological findings, and outcome. RESULTS: The overall incidence of postoperative ACS was 16%, occurring in nine of 51 patients having cholecystectomy and in seven of 48 patients having splenectomy. Mean time to onset of symptoms was 49 hr after surgery (range, 24-96 hr). Cough, fever, and an abnormal chest examination were documented for all patients at presentation. Radiologically, ACS involved the basal lobes in all cases and was multi-lobar in 25%. Patients were more likely to have new infiltrates involving the lung on the side of the surgery or bilateral infiltrates than isolated contralateral infiltrates at presentation (P < 0.0001). Isolated upper or middle lobe involvement did not occur. Fifty percent of cases demonstrated evidence of a pleural effusion. CONCLUSION: ACS complicating cholecystectomy or splenectomy shows a predilection for basal lung regions and for the lung on the side of surgery. These results have implications for the pathogenesis and prevention of postoperative ACS.     

Perioperative management of patients undergoing lung transplantation

This review focuses on recent developments in the perioperative management of patients undergoing lung transplantation. Relevant current literature and the experience of the Munich Lung Transplant Group were taken into consideration. Recent advances include the use of inhalational nitric oxide for the treatment of early graft dysfunction and the use of aerosolized cyclosporine for the treatment of recurrent and steroid-resistant acute rejection. Opportunistic infections remain a major source of morbidity and mortality in lung transplant recipients.     

胸肺顺应性对异氟醚肺泡浓度的影响

目的　观察异氟醚麻醉时不同胸肺顺应性 ( CT)对异氟醚肺泡浓度 ( FA)的影响。方法　60例非开胸手术病人分为 3组 ,每组 2 0例 ;A组 CT>61ml/ cm H2 O,B组 CT为 4 1～ 60 ml/ cm H2 O,C组 CT<4 0 ml/ cm H2 O。记录在氧流量为 1L / min,异氟醚挥发浓度为 1.5 vol%时的 FA 的变化 ,观察时间为 2 0分钟。结果　 C组的 FA 在所观察的各个时间点 ,都明显高于 A、B两组 ( P<0 .0 5或 P<0 .0 1)。结论　在异氟醚麻醉期间 CT良好者 ,FA 上升较慢 ,而 CT差者 ,FA 上升较快。可能与年龄及肺部病变有关。     

Effect of methylprednisolone on the cytokine response in patients undergoing lung surgery

Tumour necrosis factor α (TNFα), interleukin-l α (IL-lα) and IL-6, when released in excess, have been suggested to be important host mediators of the immunoinflammatory response to injury and infections. Corticosteroids suppress this response in vitro. This study was undertaken to investigate if a single dose of methylprednisolone (MP) could modify the cytokine response in patients undergoing lung surgery. Twenty-one patients with lung cancer were allocated randomly to treatment with MP 30 mg/kg i.v. (MP group) or isotonic saline (control group). Patients were anaesthetized with a balanced anaesthesia combined with thoracic epidural anaesthesia. MP or saline was administered immediately before induction of anaesthesia. The cytokines in plasma were measured by ELISA, and blood samples were collected preoperatively, at the end of surgery, 4 h later, and 1 and 5 days postoperatively. All patients had detectable IL-6 in plasma. Compared to preoperative values, plasma IL-6 levels in the MP group increased from 114 pg/ml (12–350 pg/ml) (mean, range) to peak value 146 pg/ml (15–580 pg/ml) on the first postoperative day. In the control group, IL-6 levels increased from 99 pg/ml (17–350 pg/ml) preoperatively to 125 pg/ml (10–300 pg/ml) on the first postoperative day. The increases were not significant. TNFα was detectable in only two patients, one from each group. Low levels of IL-la were demonstrated in three patients in the MP group and in four patients in the control group. In conclusion, the results of this study do not warrant steroid therapy as a modality to modify the secretion of cytokines in non-infected surgical patients, as the systemic cytokine responses were remarkably low.     

Nutritional status of patients undergoing lung cancer operations

BACKGROUND: Patients referred for lung cancer operations were reported to be nutritionally depleted. This may be relevant in determining patient outcome after surgical procedures. A study was undertaken to measure a range of nutritional variables including dietary intake of patients referred to a regional cardiothoracic center for curative lung cancer operations. METHODS: Anthropometric measurements, grip strength, fat-free mass (FFM), serum protein concentrations, lymphocyte count, creatinine-height index, subjective global assessment, and data on daily intakes of energy, protein, and vitamin C were collected prospectively. Anthropometric indices were also measured in a group of control patients with mild chronic obstructive pulmonary disease. RESULTS: Sixty patients and 22 control patients were recruited. Weight, skin-fold thickness, and grip strength were not significantly different between patients and control patients, and both groups were similar to the general population. However, 8 patients (13.3%) had a body mass index (BMI) less than 20, and 14 patients (24.1%) had a fat-free mass index less than 15. Serum albumin and transferrin concentrations and lymphocyte count were very rarely depressed but prealbumin and retinol-binding protein levels were below normal in 11.9% and 8.3% of patients, respectively. Thirty percent of patients reported low energy intake, 13% reported a low protein intake, and 61.7% had reduced vitamin C intake. CONCLUSIONS: Severe nutritional depletion was uncommon in patients referred for operations for lung cancer and its frequency may have been overestimated in some previous reports. A low intake of vitamin C was common in our patients but its clinical significance is unclear.