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肺移植围手术期治疗经验总结:附7例报告

林婷 吴齐飞 冶春娟 付军科 张广健 张勇 王哲 王铮 刘昌

林婷, 吴齐飞, 冶春娟, 等. 肺移植围手术期治疗经验总结:附7例报告[J]. 器官移植, 2019, 10(1): 74-78. doi: 10.3969/j.issn.1674-7445.2019.01.011
引用本文: 林婷, 吴齐飞, 冶春娟, 等. 肺移植围手术期治疗经验总结:附7例报告[J]. 器官移植, 2019, 10(1): 74-78. doi: 10.3969/j.issn.1674-7445.2019.01.011
Lin Ting, Wu Qifei, Ye Chunjuan, et al. Experience of perioperative treatment of lung transplantation: report of 7 cases[J]. ORGAN TRANSPLANTATION, 2019, 10(1): 74-78. doi: 10.3969/j.issn.1674-7445.2019.01.011
Citation: Lin Ting, Wu Qifei, Ye Chunjuan, et al. Experience of perioperative treatment of lung transplantation: report of 7 cases[J]. ORGAN TRANSPLANTATION, 2019, 10(1): 74-78. doi: 10.3969/j.issn.1674-7445.2019.01.011

肺移植围手术期治疗经验总结:附7例报告

doi: 10.3969/j.issn.1674-7445.2019.01.011
基金项目: 

陕西省自然科学基金项目 2018JM7013

西安交通大学第一附属医院青年科学创新基金 2017QN-13

详细信息
    作者简介:

    林婷,女,1986年生,博士研究生,主治医师,研究方向为外科危重症围手术期、器官移植,Email:947119451@qq.com

    通讯作者:

    付军科,男,1964年生,博士,教授,研究方向为食管癌、肺癌及肺移植的基础及临床研究,Email: xiaoyishuo@163.com

    刘昌,女,1967年生,博士,教授,研究方向为肝胆及外科危重疾病基础与临床研究,Email:eyrechang@126.com

  • 中图分类号: R617, R563

Experience of perioperative treatment of lung transplantation: report of 7 cases

More Information
  • 摘要:   目的  总结肺移植治疗终末期肺病的围手术期治疗经验。  方法  回顾性分析7例肺移植受体的围手术期临床资料,其中行双肺移植3例,单肺移植4例。观察肺移植受体的围手术期情况以及预后情况。  结果  7例受体肺移植手术时间为(344±133)min。4例单肺移植的冷缺血时间为(236±74)min,3例双肺移植的两侧冷缺血时间为(480±120)min。重症监护室(ICU)停留时间为21(13~25)d,住院时间为101(64~117)d。术后前3 d中每日的出量均大于入量,差异均有统计学意义(均为P < 0.05)。肺移植受体术后前3 d动脉血氧分压(PaO2)明显高于术前,差异均有统计学意义(均为P < 0.05),而动脉二氧化碳分压(PaCO2)未见明显变化,差异均无统计学意义(均为P > 0.05)。肺移植受体术后均出现肺部细菌感染,其中3例合并真菌感染;1例受体术后因胸腔活动性出血行剖胸探查止血术,1例受体术后出现原发性移植物失功(PGD),4例受体行二次气管插管。术后死亡2例,其中1例死于多重耐药鲍曼不动杆菌败血症;1例死于自行停用免疫抑制剂后的排斥反应;其余5例均顺利出院且恢复良好,最长生存期为3.1年。  结论  肺移植围手术期管理中,手术适应证的把握、术后精细化液体和血流动力学的监测与管理、肺保护性通气策略的实施、术后严重并发症的早期诊断及治疗,对肺移植受体安全渡过围手术期具有重要意义。

     

  • 图  1  7例肺移植受体术后3 d入量和出量的比较

    Figure  1.  Comparison of intake and output of 7 recipients in the first 3 days after lung transplantation

    图  2  7例肺移植受体术前和术后PaO2的比较

    Figure  2.  Comparison of PaO2 of 7 recipients before and after lung transplantation

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出版历程
  • 收稿日期:  2018-10-20
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2019-01-15

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