达芬奇机器人辅助单侧肺移植患者术后重症监护

总结1例达芬奇机器人辅助单侧肺移植术后患者重症监护经验。护理要点包括移植肺机械通气管理；严格限制患者液体入量，尤其注重控制隐形液体入量；进行规范的抗感染及免疫抑制治疗；早期行肠内营养支持和肺功能康复锻炼。患者入住重症监护室15 d后转至普通病房，继续住院治疗观察4 d后，顺利康复出院。     

达芬奇机器人辅助单侧肺移植患者术后重症监护

总结1例达芬奇机器人辅助单侧肺移植术后患者重症监护经验。护理要点包括移植肺机械通气管理；严格限制患者液体入量，尤其注重控制隐形液体入量；进行规范的抗感染及免疫抑制治疗；早期行肠内营养支持和肺功能康复锻炼。患者入住重症监护室15 d后转至普通病房，继续住院治疗观察4 d后，顺利康复出院。     

Outcomes of telehealth care for lung transplant recipients

Telehealth uses videoconferencing to provide long‐distance clinical care. Experience with telehealth in the setting of organ transplantation is limited. The purpose of this cohort study was to compare the impact of telehealth vs in‐person follow‐up of lung transplant recipients. Telehealth eligible patients were three or more years post‐transplant and resided in Ontario outside the Greater Toronto Area. Patients with initial telehealth visits between July 1, 2009, and Dec 31, 2014, were retrospectively reviewed to assess outcomes of chronic lung allograft dysfunction progression and mortality until December 31, 2016, compared with eligible patients seen in‐person. Of eligible patients (n = 204), 119 (58.3%) were seen via telehealth. Most patients (97%) rated telehealth as equivalent or superior to clinic visits. Telehealth visits resulted in significant out‐of‐pocket cost savings and travel distance savings for patients. There was no significant difference in mortality from the time of first visit (HR 0.81, 95% CI 0.49‐1.32, P = 0.4) or from the time of transplant between groups (HR 0.72, 95% CI 0.43‐1.17, P = 0.2). Telehealth can safely and effectively be used in select transplant recipients to increase access to care and reduce time and financial burdens for patients residing greater distances from primary transplant centers.     

同种异体肺移植术的手术配合

１例右肺支气管扩张，右侧毁损肺患者行右肺全切除加同种异体肺移植术。重点阐述了该手术前准备，包括器械，物品准备，术中配合包括供肺修整与保护，受体肺切除，供肺与受体的吻合等。并就术前准备、人员培训，预防感染等进行了讨论。     

Elimination of pancoast tumor by carboplatin, paclitaxel, and concurrent radiation

Preoperative chemoradiotherapy with carboplatin (AUC 1.5), paclitaxel (40 mg/m²), and concurrent extracorporeal radiation (40 Gy) was used to treat a Pancoast tumor (clinical T3N0M0), without causing adverse events. Then left upper lobectomy was performed along with mediastinal lymph node dissection plus resection of the chest wall and Th, nerve root. Histological examination revealed a pathological complete response. This multimodal regimen was feasible and achieved a good response, so it seems worthwhile to evaluate the clinical effectiveness of the therapy in a cohort study.     

Acute lung injury

Acute lung injury is a clinically and radiologically defined syndrome which is commonly diagnosed in intensive care. This article describes the epidemiology, pathology and pathophysiology as well as current management strategies with supporting evidence where available.     

Pirfenidone exerts beneficial effects in patients with IPF undergoing single lung transplantation

Pirfenidone demonstrated pleiotropic antiinflammatory effects in various experimental and clinical settings. The aim of this study was to assess the impact of previous treatment with pirfenidone on short‐term outcomes after single lung transplantation (SLTx). Therefore, patients with idiopathic pulmonary fibrosis (IPF) who were undergoing SLTx were screened retrospectively for previous use of pirfenidone and compared to respective controls. Baseline parameters and short‐term outcomes were recorded and analyzed. In total, 17 patients with pirfenidone were compared with 26 patients without antifibrotic treatment. Baseline characteristics and severity of disease did not differ between groups. Use of pirfenidone did not increase blood loss, wound‐healing, or anastomotic complications. Severity of primary graft dysfunction at 72 hours was less (0.3 ± 0.6 vs 1.4 ± 1.3, P = .002), and length of mechanical ventilation (37.5 ± 34.8 vs 118.5 ± 151.0 hours, P = .016) and intensive care unit (ICU) stay (6.6 ± 7.1 vs 15.6 ± 20.3, P = .089) were shorter in patients with pirfenidone treatment. An independent beneficial effect of pirfenidone was confirmed by regression analysis while controlling for confounding variables (P = .016). Finally, incidence of acute cellular rejections within the first 30 days after SLTx was lower in patients with previous pirfenidone treatment (0.0% vs 19.2%; P = .040). Our data suggest a beneficial role of previous use of pirfenidone in patients with IPF who were undergoing SLTx.     

Quality of recipient–caregiver relationship and psychological distress are correlates of self‐care agency after lung transplantation

Self‐care behaviors are crucial for following the complex regimen after lung transplantation, yet little is known about recipients' levels of self‐care agency (the capability and willingness to engage in self‐care behaviors) and its correlates. We examined levels of self‐care agency and recipient characteristics (socio‐demographics, psychological distress, quality of relationship with primary lay caregiver, and health locus of control) in 111 recipients. Based on Perceived Self‐Care Agency scores, recipients were assigned to either the low‐ or high‐self‐care agency comparison group. Characteristics were compared between groups to identify characteristics likely to be associated with lower‐self‐care agency. Mean (SD) score for self‐care agency (scale range, 53–265) was 223.02 (22.46). Recipients with lowest‐self‐care agency scores reported significantly poorer quality of caregiver relationships (p < 0.001) and greater psychological distress (p < 0.001). After controlling for psychological distress, the quality of the recipient–caregiver relationship remained significantly associated with self‐care agency. Every one‐point decrease in the quality of caregiver relationship increased the risk of low‐self‐care agency by 12%. Recipients with poorer caregiver relationships and greater psychological distress may need additional support to perform the self‐care behaviors expected after lung transplantation.     

支气管动脉灌注LAK细胞和化疗药物联合治疗肺癌的护理

对１０例中晚期肺癌患者采用支气管动脉灌注ＬＡＫ细胞和化疗药物联合治疗，取得良好疗效。充分做好术前准备，术中医护密切配合，严格执行无菌操作，加强留置导尿护理，仔细观察用药后不良反应以及做好拔管后的护理，对提高疗效、减少副作用有重要意义。１０例患者２６次治疗无并发症发生。     

Predictors and outcomes of unplanned early rehospitalization in the first year following lung transplantation

Unplanned early rehospitalization (UER), defined as an unscheduled admission within 30 days of a hospital discharge, is associated with graft loss and recipient mortality in some solid organ transplants but has not been investigated in lung transplant. In this retrospective study, we collected socio‐demographic and clinical factors to determine predictors and outcomes of UER in the first year following lung transplantation. There were 193 patients who underwent lung transplantation and survived to discharge during the 7.9‐year study period. There were 116 (60.1%) patients with at least one UER. Infections (32.8%) and post‐surgical complications (11.8%) were the most common reasons for UER. On multivariate analysis, the strongest predictor of having an UER was discharge to a long‐term acute care facility (odds ratio: 3.01, 95% confidence interval [CI] 1.46–6.20; P=.003). Patients with any UER in the first year following transplantation had worse adjusted survival (hazard ratio: 1.89, 95% CI 1.02–3.50; P=.04). It is unclear, however, to what extent UERs reflect preventable outcomes. Further large‐scale, prospective research is needed to identify the extent to which certain types of UER are modifiable and to define patients at high‐risk for preventable UER.     

肺癌患者生活质量与应对方式及其相关性研究

目的探讨肺癌患者的生活质量与应对方式及其相关性,以寻找提高生活质量的护理对策。方法采用癌症患者生存质量量表（EROTCQLQ-C30）和医学应对问卷（MCMQ）,分别对31例住院肺癌患者（患者组）和31名健康成人（对照组）进行调查。结果患者组生活质量评分显著低于健康对照组,患者最常采用的应对方式依次为面对或斗争、回避、屈服或接受;屈服或接受应对方式与肺癌患者生活质量呈负相关（P〈0．05,P〈0．01）。结论肺癌患者生活质量显著降低,但首要采用积极面对;在护理工作中,指导患者尽量避免屈服心理,以提高生活质量。