ObjectiveTo explore the effect of continuous nursing on lung transplant patients at home based on humanistic care. MethodsAccording to hospitalization order, patients who received lung transplantation in our hospital from January 2016 to October 2020 were divided into a control group and a nursing group. The control group was treated with routine lung transplantation education and regular follow-up after discharge, and the nursing group received humanistic care during follow-up, health education at discharge, cultural exchange activities, and home care plans. After discharge, the self-management ability at home, medication adherence and satisfaction of home care between the two groups were campared. ResultsA total of 60 patients were included in the study. There were 23 patients in the control group, including 16 males and 7 females, with an average age of 58.70±11.00 years. There were 37 pateints in the nursing group, including 25 males and 12 females, with an average age of 57.90±13.20 years. The scores of self-management ability at home of the nursing group (self-concept 27.41±2.37 points vs. 21.78±3.54 points; self-care responsibility 20.73±1.63 points vs. 16.83±2.79 points; self-care skills 41.46±3.77 points vs. 28.26±4.11 points; health knowledge level 57.95±4.10 points vs. 44.87±5.79 points) were higher than those in the control group (all P＜0.05). The medication adherence (7.47±0.46 points vs. 6.87±0.28 points) and satisfaction of home care (23.80±1.20 points vs. 20.50±1.90 points) in the nursing group were higher than those in the control group (both P<0.05). ConclusionContinuous nursing based on humanistic care for lung transplant patients can effectively improve the self-management ability, medication adherence and nursing satisfaction of patients after discharge.
Objective To establish a simple, valid rat orthotopic left lung transplantation model with the improved operation technique. Methods One hundred and thirty-six male SD rats were randomly divided into donor （n = 68） and recipient （n = 68）, transplantation were performed by using the improved cuff anastomosis technique. Results Time of donor lung perfusion-picking, donor lung vessel cuff anastomosis and recipient vessel anastomosis was 13±2 min, 9±1 min, 10±1 min respectively, the operative time was 60±3 min. In 68 rats of operations, successful rate was 88%（60/68）, anastomotic stoma leak in one rat, lung congestion 3 rats, lung atelectasis 4 rats. The shortest survival time was 1 day, there were 53 rats whose survival time was longer than 12 days. The chest computed tomography showed no atelectasis and blood gas analysis manifested good respiratory function. Conclusion The improved three cuff anastomosis technique offers a simple, valid, cheap and useful method,it can establish rat orthotopic left lung transplantation model successfully.
Objective To examine the effect of endothelial progenitor cell (EPC) on lung ischemia-reperfusion injury (LIRI). Methods Twenty-four recipients were randomized into 3 groups including a sham group, a LIRI group, and an EPC group. Rats in the sham group only received anesthesia. Rats in the LIRI and EPC groups received left lung transplantation and received saline or EPC immediately after reperfusion. The partial pressure of oxygen to fraction of inspiratory oxygen (PaO2/FiO2) ratio, wet-to-dry weight ratio and protein levels in the transplanted lung and inflammation-related factors levels in serum were examined. Histological change of transplanted lung were analyzed. The nuclear factor (NF)-κB in the transplanted lung was detected. Results Compared with the LIRI group, the PaO2/FiO2 ratio dramaticly increased, and the wet-to-dry weight ratio and protein level significantly decreased by EPC after reperfusion. The lung histological injury was attenuated by EPC. The pro-inflammatory factors in serum were down-regulated, whereas IL-10 was up-regulated in the EPC group. The expression of NF-κB was decreased by EPC. Conclusion EPC ameliorated LIRI after lung transplantation. The protection of EPC partly associated with anti-inflammation.
With the deepening of current study and the innovation of perioperative management concept, there have been great advances in lung transplantation in recent years. The prognosis of patients has been significantly improved. At the same time, the role of various types of blood purification in the clinical monitoring and treatment of lung transplant patients is becoming increasingly prominent. This review aims to summarize the application and latest progress of in vitro blood purification such as renal replacement therapy, plasmapheresis and hemadsorption in the perioperative period of lung transplantation, and to provide a basis for further study.
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic at the end of December 2019, more than 85% of the population in China has been infected. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mainly affects the respiratory system, especially the lungs. The mortality rate of patients with severe infection is high. A percentage of 6% to 10% of patients will eventually develop into COVID-related acute respiratory distress syndrome (CARDS), which requires mechanical ventilation and extracorporeal membrane oxygenation (ECMO) support. Some patients who survive acute lung injury will subsequently develop post COVID-19 pulmonary fibrosis (PCPF). Both fully treated CARDS and severe PCPF are suitable candidates for lung transplantation. Due to the special course, evaluation strategies are different from those used in patients with common end-stage lung disease. After lung transplantation in COVID-19 patients, special treatment is required, including standardized nucleic acid testing for the novel coronavirus, adjustment strategy of immunosuppressive drugs, and rational use of antiviral drugs, which is a big challenge for the postoperative management of lung transplantation. This consensus was evidence-based written and was reached by experts after multiple rounds of discussions, providing reference for assessment and postoperative management of patients with interstitial pneumonia after COVID-19 infection.
Non-heart-beating donor is an important source for lung transplantation, and has been successfully used in clinical practice for many years with satisfactory outcomes. But donor shortage, imperfect lung preservation techniques and ethical controversies still limit the development of non-heart-beating donor. In recent years, with continuous scientific progress, great progress has been made in each aspect of non-heart-beating donor. Here we review the clinical categories, ischemia time, death determination, ethical progress, and lung preservation techniques of non-heart-beating donor.
目的总结心脏移植和双肺移植供体心肺同时摘取的经验。 方法解放军第一八一医院心脏中心2012年完成3例同一供体心肺同时摘取，分别完成心脏移植和双肺移植各3例。3例供体为脑死亡，阻断供体升主动脉和主肺动脉后，同时灌注保护液，心脏保护应用组氨酸-色氨酸-酮戊二酸心脏停搏液（HTK液），肺保护应用低钾右旋糖酐液（LPD液）；供体心肺热缺血时间为5 min，供心冷缺血时间分别为252 min、323 min和375 min，供体肺冷缺血时间分别为610 min、679 min和738 min；3例心脏移植均采用双腔静脉吻合法，3例肺移植均采用序贯式双肺移植。 结果3例心脏移植均存活；肺移植2例存活，1例死亡。存活患者出院后生活质量良好，随访8～13个月未出现感染、急性排斥反应等并发症。 结论供体心肺同时摘取，同时灌注后分别修剪并再次灌注，分别保存运输，心脏移植和双肺移植可取得满意效果。
Lung transplantation has been proved to be an effective treatment after more than forty years of fast development, while more than 4000 cases of lung transplantation performed globally each year. Recently, lung transplantation in China has been advanced rapidly, and the number of transplants has increased year by year. Respiratory and Critical Care Medicine team has been recognized to play a crucial role in lung transplantation. It has an irreplaceable role and status in promoting lung transplantation, improving the preoperative evaluation of lung transplantation and the maintenance of donors, and carrying out perioperative management, as well as long-term follow-up. Lung transplantation is a systematic project, requiring the perfect cooperation and collaboration of team members and contributing to recipients’ recovery.