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find Keyword "肺" 3554 results
  • Intra-pulmonary Artery Infusion of Antitumor Necrosis Factor-α Antibody Attenuates Lung Injury after Cardiopu-lmonary Bypass

    Objective To investigate the protective effects of antitumor necrosis factor-α antibody (TNF-αAb) on lung injury after cardiopulmonary bypass (CPB) and their mechanisms. Methods Forty healthy New Zealand white rabbits,weighting 2.0-2.5 kg,male or female,were randomly divided into 4 groups with 10 rabbits in each group. In groupⅠ,the rabbits received CPB and pulmonary arterial perfusion. In group Ⅱ,the rabbits received CPB and pulmonary arterial perfusion with TNF-αAb. In group Ⅲ,the rabbits received CPB only. In group Ⅳ,the rabbits only received sham surgery. Neutrophils count,TNF-α and malondialdehyde (MDA) concentrations of the blood samples from the left and right atrium as well as oxygenation index were examined before and after CPB in the 4 groups. Pathological and ultrastructural changes of the lung tissues were observed under light and electron microscopes. Lung water content,TNF-α mRNA and apoptoticindex of the lung tissues were measured at different time points. Results Compared with group Ⅳ,after CPB,the rabbitsin group Ⅰ to group Ⅲ showed significantly higher blood levels of neutrophils count,TNF-α and MDA(P<0.05),higherTNF-α mRNA expression,apoptosis index and water content of the lung tissues (P<0.05),and significantly lower oxyg-enation index (P<0.05) as well as considerable pathomorphological changes in the lung tissues. Compared with group Ⅱ,after CPB,the rabbits in groups Ⅰ and Ⅲ had significantly higher blood concentrations of TNF-α (5 minutes after aortic declamping,220.43±16.44 pg/ml vs.185.27±11.78 pg/ml,P<0.05;249.99±14.09 pg/ml vs.185.27±11.78 pg/ml,P<0.05),significantly higher apoptosis index (at the time of CPB termination,60.7‰±13.09‰ vs. 37.9‰±7.78‰,P<0.05;59.6‰±7.74‰ vs. 37.9‰±7.78‰,P<0.05),significantly higher blood levels of neutrophils count and MDA (P<0.05),significantly higher TNF-α mRNA expression and water content of the lung tissues (P<0.05),and significantly loweroxygenation index (P<0.05) as well as considerable pathomorphological changes in the lung tissues. Compared with groupⅠ,rabbits in group Ⅲ had significantly higher above parameters (P<0.05) but lower oxygenation index (P<0.05) only at 30 minutes after the start of CPB. Conclusion Pulmonary artery perfusion with TNF-αAb can significantly attenuate inflammatory lung injury and apoptosis of the lung tissues during CPB.

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • Application of CT-guided microcoil localization in single utility port video-assisted thoracoscopic surgery for small pulmonary nodules (diameter≤15 mm): A retrospective cohort study

    ObjectiveTo explore the application value of CT-guided microcoil localization in pulmonary nodule (diameter≤15 mm) surgery.MethodsThe clinical data of 175 patients with pulmonary nodules who underwent single utility port video-assisted thoracoscopic surgery at Nanjing Drum Tower Hospital from August 2018 to December 2019 were retrospectively analyzed. According to whether CT-guided coil localization was performed before operation, they were divided into a locating group and a non-locating group. There were 84 patients (34 males, 50 females, aged 57.8±8.8 years) in the locating group and 91 patients (46 males, 45 females, aged 57.6±10.8 years) in the non-locating group. The localization success rate, localization time, incidence of complications, surgical and postoperative conditions were analyzed between the two groups.ResultsAll 84 patients in the locating group were successfully located, and localization time was 19.0±3.6 minutes. Among them, 19 (22.6%) patients had a small pneumothorax, 4 (4.8%) pulmonary hemorrhage and 2 (2.4%) coil shift; 6 (7.1%) patients had mild pain, 3 (3.6%) moderate pain and 1 (1.2%) severe pain. Sex (P=0.181), age (P=0.673), nodule location (P=0.167), nature of lesion (P=0.244), rate of conversion to thoracotomy (P=0.414), rate of disposable resection of nodules (P=0.251) and postoperative hospital stay (P=0.207) were similar between the two groups. There were significant differences in nodule size (P<0.001), nature of nodule (P<0.001), the shortest distance from nodule to pleura (P<0.001), operation time (P<0.001), lung volume by wedge resection (P=0.031), number of staplers (P<0.001) and total hospitalization costs (P<0.001) between the two groups.ConclusionCT-guided microcoil localization has the characteristics of high success rate, and is simple, practicable, effective, safe and minimally invasive. Preoperative CT-guided microcoil localization has important clinical application value for small pulmonary nodules, especially those with small size, deep location and less solid components. It can effectively shorten the operation time, reduce surgical trauma and lower hospitalization costs, which is a preoperative localization technique worthy of popularization.

    Release date:2022-01-21 01:31 Export PDF Favorites Scan
  • 肺曲菌病的诊断与外科治疗

    目的 总结肺曲菌病的诊断和外科治疗经验。 方法 57例肺曲菌病患者中17例(29.8%)术前已明确诊断,21例(36.8%)于术前误诊为肺结核、肺部占位病变、肺囊肿和肺脓肿等,19例(33.3%)术前漏诊。行肺叶切除术27例,肺段或肺楔形切除术18例;在电视胸腔镜辅助下行肺段或局部病变切除术5例,电视胸腔镜辅助下小切口肺楔形切除或局部病变切除术7例。 结果 无住院死亡。术后出现包裹性液气胸4例,胸腔积液、积气2例,切口感染1例,肺部感染3例,均经3~7d的相应处理治愈。术后积极治疗肺部基础疾病,同时均给予氟康唑400mg/d,治疗4~8周。所有患者均得到随访,随访时间6个月~12年,肺曲菌病未复发,患者生活质量良好。 结论 肺曲菌病误诊、漏诊率高,术前应加强对肺曲菌病的认识,认真检查诊断;手术切除病变是治疗肺曲菌病的有效方法。

    Release date:2016-08-30 06:15 Export PDF Favorites Scan
  • 肺动脉介入化疗在Ⅲa期非小细胞肺癌患者术 后治疗中的应用

    目的 总结Ⅲa期非小细胞肺癌患者根治术后行肺动脉介入化疗的临床经验。 方法 对2000年10月至2003年10月收治的非小细胞肺癌患者行手术根治治疗,术后住院号为偶数的前20例患者(肺动脉介入组)行肺动脉介入化疗,采用卡铂(60~80mg/m2•d)1~3d,足叶乙甙(60mg/m2•d)1~3d,丝裂霉素(4 mg/m2•d)1d,或5氟脲嘧啶(250 mg/m2•d)1~3d,每4周为1个周期,共4个周期。住院号为奇数的前20例患者(对照组)术后给予外周静脉化疗,作为对照。采用卡铂(100mg/m2•d)1~3d,足叶乙甙(120mg/m2•d)1~3d,丝裂霉素(8 mg/m2•d)1d,或5氟脲嘧啶(500mg/m2•d)1~3d,每4周为1个周期,共4个周期。 结果 全组患者无手术死亡,肺动脉介入组患者骨髓抑制和消化道反应均较对照组明显减轻。肺动脉介入组患者2年、3年生存率高于对照组(Plt;0.05),N1患者生存率高于N2患者。肺动脉介入组肿瘤远处转移部位为骨、脑,而对照组转移部位为骨、脑、纵隔、对侧肺、肝和肾上腺等器官。 结论 Ⅲa期非小细胞肺癌患者行根治术后采用肺动脉介入化疗的效果优于外周静脉化疗法。

    Release date:2016-08-30 06:08 Export PDF Favorites Scan
  • Implementation of A Real-time Compliance Dashboard to Help Reduce Ventilator-Associated Pneumonia with Ventilator Bundle

    Objective To investigate the effect of a real-time compliance dashboard to help reduce ventilator-associated pneumonia ( VAP) with ventilator bundle. Methods 240 patients who were admitted into the intensive care unit ( ICU) of Shougang Hospital of Peking University and had received mechanical ventilation ( MV) for over 48 hours, between January 2010 and November 2011, were studied prospectively. The patients were divided into two groups by random number table, ie. a dashboard group ( n = 120) with implementation of a real-time compliance dashboard to help reduce VAP with ventilator bundle, and a control group ( n=120) with implementation of usually routine order to help reduce VAP with ventilator bundle. The success rate of ventilator bundle implementation, incidence of VAP, duration of MV, duration within ICU, mortality within 28 days, cost within ICU were compared between two groups. Results Compared with the control group, the success rate of ventilator bundle implementation obviously increased ( 81.6% vs. 52.5%) , incidence of VAP ( 14. 5/1000 days of MV vs. 36.2 /1000 days of MV) , duration of MV [ 5( 4,7) days vs. 8( 6,11) days] , duration within ICU [ 8( 6,12) days vs. 13( 8,16) days] , mortality of 28 days ( 12.6% vs. 28.6% ) , and cost within ICU ( 36,437 vs. 58,942) in the dashboard group obviously reduced ( Plt;0.05) . Conclusions Implementation of a real time compliance dashboard to help reduce VAP with ventilator bundle can obviously improve medical personnel compliance and reduce incidence of VAP, duration of MV, duration within ICU, mortality and cost in ICU than those of routine medical order to help reduce VAP with ventilator bundle.

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  • 心肺转流术致未成熟肺损伤及其保护的研究现状

    心肺转流术(CPB)所致未成熟肺损伤,是婴幼儿心脏手术后严重的并发症,直接影响心脏手术的成功率,但其损伤机制及如何有效地施行保护,一直是个亟待解决的问题.研究结果发现,心肺转流时外源性物质激活补体介导全身炎症是肺损伤

    Release date:2016-08-30 06:34 Export PDF Favorites Scan
  • Diagnosis and Treatment for Acute Pulmonary Embolism after Video-assisted Thoracoscopic Lobectomy

    Abstract: Objective To investigate strategies for prevention,early diagnosis,and prompt treatment for acute pulmonary embolism(PE)after video-assisted thoracoscopic surgery(VATS)lobectomy. Methods From January 2007 to November 2010, 1 115 patients with lung cancer underwent VATS lobectomy in the First Affiliated Hospital of Guangzhou Medical College. Among them, 13 patients had acute PE postoperatively, including 6 male patients and 7 female patients with their mean age of 62.3 years(ranging from 42 to 73 years).All the patients were diagnosed by spiral CT pulmonary artery angiography(SCTPA), and received anticoagulation therapy with low molecular weight heparin and warfarin. Results The incidence of acute PE after VATS lobectomy was 1.17%(13/1 115), and the patients with low PE-related early mortality risk accounted for a large proportion(11/13). There were 12 patients with right-side PE. All the patients’ signs and symptoms were significantly alleviated after administration of anticoagulation therapy. Nine patients received SCTPA review after treatment which showed that their PE had disappeared or been significantly absorbed. No hematological complications including thoracic hemorrhage or wound errhysis occurred after treatment. All surviving patients were followed up for 1 month to 3 months. During follow-up, these patients were alive without PE recurrence. Conclusion SCTPA is the first-choice examination for the diagnosis of acute PE after VATS lobectomy. Prophylaxis against PE and prompt treatment are necessary depending on individual manifestations. VATS lobectomy should be favored as a minimally invasive surgical treatment for patients with lung cancer, for the low incidence of postoperative PE and low PE-related early mortality risk.

    Release date:2016-08-30 05:49 Export PDF Favorites Scan
  • Logistic Regressive Analysis of Prognostic Factors for Patients with Return of Spontaneous Circulation

    目的:探讨心肺复苏循环恢复患者早期评估预后的相关因素。方法:对56例心肺复苏循环恢复患者进行病例回顾分析,分别记录患者年龄、性别以及心肺复苏循环恢复1小时内的瞳孔直径、格拉斯高昏迷评分、血WBC计数、血清肌酐Cr、血清丙氨酸氨基转移酶ALT、肌酸磷酸激酶、D-二聚体定性、血钙、血钾、血清淀粉酶、复苏后1小时内是否使用亚低温治疗、pH值、动脉血氧分压PaO2、动脉血二氧化碳分压PaCO2、血葡萄糖、复苏时间等, 采用多因素logistic回归模型分析心肺复苏循环恢复患者的预后因素。结果:回顾56例心肺复苏循环恢复患者病例, logistic回归分析发现血清淀粉酶、血糖和复苏时间对早期评估心肺复苏循环恢复患者的预后有意义。结论:复苏后1小时内血清淀粉酶、血糖和复苏时间对早期评估心肺复苏循环恢复患者的预后有价值。

    Release date:2016-09-08 10:04 Export PDF Favorites Scan
  • 盐酸氨溴索佐治小儿支气管肺炎疗效比较

    目的 探讨盐酸氨溴索注射液佐治小儿支气管肺炎的临床疗效。 方法 将2008 年1月-2009年1月收治的小儿支气管肺炎60例,随机分为治疗组和对照组各30例,在抗炎治疗的基础上,治疗组加用盐酸氨溴索注射液治疗。 结果 治疗组治愈率为100%,对照组治愈率为86.7%。治疗组的肺部啰音吸收时间、胸部X线片恢复正常时间均较对照组短。 结论 盐酸氨溴索佐冶小儿支气管肺炎疗效确定,值得临床应用。

    Release date:2016-09-08 09:47 Export PDF Favorites Scan
  • Noninvasive Positive Pressure Ventilation in Acute Lung Injury and Acute Respiratory Distress Syndrome:A Randomized Controlled Study

    Objective To evaluate the efficiency and associated factors of noninvasive positive pressure ventilation( NPPV) in the treatment of acute lung injury( ALI) and acute respiratory distress syndrome( ARDS) .Methods Twenty-eight patients who fulfilled the criteria for ALI/ARDS were enrolled in the study. The patients were randomized to receive either noninvasive positive pressure ventilation( NPPV group) or oxygen therapy through a Venturi mask( control group) . All patients were closely observed and evaluated during observation period in order to determine if the patients meet the preset intubation criteria and the associated risk factors. Results The success rate in avoiding intubation in the NPPV group was 66. 7%( 10/15) , which was significantly lower than that in the control group ( 33. 3% vs. 86. 4% , P = 0. 009) . However, there was no significant difference in the mortality between two groups( 7. 7% vs.27. 3% , P =0. 300) . The incidence rates of pulmonary bacteria infection and multiple organ damage were significantly lower in the NPPV success subgroup as compared with the NPPV failure group( 2 /10 vs. 4/5, P =0. 01;1 /10 vs. 3/5, P = 0. 03) . Correlation analysis showed that failure of NPPV was significantly associated with pulmonary bacterial infection and multiple organ damage( r=0. 58, P lt;0. 05; r =0. 53, P lt;0. 05) . Logistic stepwise regression analysis showed that pulmonary bacterial infection was an independent risk factor associated with failure of NPPV( r2 =0. 33, P =0. 024) . In the success subgroup, respiratory rate significantly decreased( 29 ±4 breaths /min vs. 33 ±5 breaths /min, P lt; 0. 05) and PaO2 /FiO2 significantly increased ( 191 ±63 mmHg vs. 147 ±55 mmHg, P lt;0. 05) at the time of 24 hours after NPPV treatment as compared with baseline. There were no significant change after NPPV treatment in heart rate, APACHEⅡ score, pH and PaCO2 ( all P gt;0. 05) . On the other hand in the failure subgroup, after 24 hours NPPV treatment, respiratory rate significantly increased( 40 ±3 breaths /min vs. 33 ±3 breaths /min, P lt;0. 05) and PaO2 /FiO2 showed a tendency to decline( 98 ±16 mmHg vs. 123 ±34 mmHg, P gt; 0. 05) . Conclusions In selected patients, NPPV is an effective and safe intervention for ALI/ARDS with improvement of pulmonary oxygenation and decrease of intubation rate. The results of current study support the use of NPPV in ALI/ARDS as the firstline choice of early intervention with mechanical ventilation.

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