Objective To study the application of pressure regulated volume control ventilation in respiratory support after liver transplantation. MethodsTwenty patients underwent liver transplantation were randomly averagely divided into two groups: pressure regulated vlume control ventilation (PRVCV) group and volume control (VC) group. The parameters of respiratory mechanics, hemodynamics and blood gas analysis of patients in two groups were compared, such as oxygen delivery (DO2), oxygen consumption (VO2), oxygen incepation ratio (O2ER), arteriovenous oxygen content difference (C(a-v)O2), cardiac output (CO), mean arterial pressure (mABP), mean pulmonary arterial pressure (mPAP), alveolar-arterial PO2 difference 〔P(A-a)O2〕, gas exchange index (PaO2/FiO2)， ratio of shunted blood to total perfusion (Qs/Qt), peak inspiratory pressure (PIP) and mean airway pressure (mAP). Results The P(A-a)O2 and Qs/Qt were significantly decreased in PRVCV group than those in VC group 〔P(A-a)O2: (101.42±28.07) mm Hg vs. (136.76±39.13) mm Hg; Qs/Qt: (1.78±0.86)% vs. (3.28±0.99)%〕, P＜0.05, P＜0.05， while the C(a-v)O2 and O2ER were significantly increased 〔C(a-v)O2: (20.70±10.41) mm Hg vs. (12.83±2.49) mm Hg; O2ER: (16.34±9.79)% vs. (9.37±1.83)%〕, P＜0.05, P＜0.01. There was no difference in the hemodynamics and airway pressure parameters between PRVCV group and VC group. Conclusion PRVCV mode could be a more suitable mechanical ventilation pattern to patients after liver transplantation.
Objective To explore the clinical epidemiological characteristics of the lung infection after orthotopical liver transplantation. Methods The clinical data included infection morbidity, mortality, infectious times and relative factors, clinical manifestations, the bacterial strains and distributions of the pathogens, the bacterial resistances of the 53 liver transplantation recipients from 2003.3～2006.12 were summarized and analyzed retrospectively. Results Among 53 recipients, 33 developed lung infectious and 6 died .The mobidity was 62.3% and mortality was 18.2%, with a OR of 1.0. Lung infection predominantly occurred in the first month, especially in the first week after transplantation.There were many factors related to lung infections.Various pathogens, especially Klebsialla, Escherichia Coli and Staphylococus Hominis were isolated from sputum, airway suction drainages and throat swabs. Most of the G- bacteria were sensitive to aminoglycosides,β lactam and lactamase compounds and carbapenems while G+ bacteria were sensitive only to glycopeptides. All the bacteria were resistant to quinolones, β lactams of third and forth generation. Conclusions After liver transplantation, the morbidity and mortality of the lung infections are high.The infections develope at earlier stage, manifest nontypical clinical features.Many factors are revealed to be relevant to the lung infections,meanwhile, various drug-resistant pathogen strains are isolated.