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題 名 | The Acute Cardiopulmonary Response to Okt3 in Lung Transplant Recipients[fec1]-[fec4]=肺臟移植病患注射OKT[feb0]引發心肺功能變化之研究 |
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作 者 | 江啟輝; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 1:1 1999.10[民88.10] |
頁 次 | 頁7-16 |
分類號 | 415.4 |
關鍵詞 | 肺臟移植; 心肺功能; OKT3 monoclonal antibody; Lung transplantation; Cardiopulmonary changes; |
語 文 | 英文(English) |
中文摘要 | 近年來,由於免疫抑制劑的進步,包括OKT�陛]一種新的單株抗體)的使用,促使移植的成功率大增。 過去病歷報告其他非肺臟移植初次使用 OKT �健|產生呼吸急促的現象,至於對肺臟移植病人所造成的心肺功能影響則尚未清楚;因此,本研究欲進一步探討肺臟移植病患於接受OKT�高`射後其心肺功能的變化。13位病患於肺臟移植24小時內靜脈注射OKT�陛]5 mg,qd),連續三天測量其血流動力的變化和動脈血中氣體分析。結果顯示,OKT�陞峏騛w防性之免疫抑制,會導致心肺功能的顯著改變;在第一次注射的一小時內會引起發燒、肺動脈壓升高、心跳加快及低血氧,但在第二次注射時,肺動脈壓升高及發燒的情況較輕,至於第三次注射時,心肺功能則沒有顯著的變化。另外,在平均肺動脈壓、cardiac index、中央靜脈壓及肺部順應性則無明顯變化。根據文獻,OKT�健|毒殺淋巴球並大量分泌細胞間素(cytokine)尤其是TNF-α。因此,吾推測OKT�骨狺獉_之心肺功能變化與發燒可能亦和細胞間素有關。這13位肺臟移植患者接受OKT�馬蚢w防移植產生排斥作用,雖然事前先給予類固醇與antihistamin來預防其副作用,但仍有輕微心肺功能變化,適當處理則無嚴重肺水腫產生。藉此研究結果,得知雖然OKT�健|引起立即性全身反應與心肺功能變化但只要先前給予類固醇,OKT�高`射其危險性並不大。但我們仍建議開始接受OKT�高`射時,應住進加護病房特別密切觀察其心肺功能變化,以便應付緊急狀況的發生! |
英文摘要 | Improvement in the outcome of transplantation can be attributed to recent advances in immunos up pression, including the use of OKT��, a new monoclonal antibody. The first dose of OKT�� induced dyspnea in transplantation was found but the cardiopulmonary changes of OKT�� in lung transplantation was not well explored yet. In this experiment, we attempted to find the cardiopulmonary response to OKT�� in lung transplant recipients. OKT�� 5 mg IV qd was given to 13 studied subjects within 24 h of lung transplantation. Serial measurements of hemodynamic changes and arterial blood gases were done for three days. Our results showed that OKT�� induced a significant change of cardiopulmonary function. Within the first hour of the first dose, patients developed fever, pulmonary hypertension, tachycardia and hypoxemia, but with less extensive pulmonary hypertension and fever after the second dose, and moreover, no changes after the third dose. There were no significant changes in mean arterial pressure, cardiac index, central venous pressure and lung compliance. The clinical course of acute cardiopulmonary response was relevant to previous studies of the time course of increases in cytokines release. Therefore, we suggest cytokine might contribute to cardiopulmonary response to OKT��. OKT�� induces a significantly transit systemic response, therefore close observation in an ICU is recommended during the initial administration of OKT�� for prompt intervention when reactions occur. |
本系統中英文摘要資訊取自各篇刊載內容。