单肺移植术后手术室内气管拔管方案的探索性研究

Exploratory study of tracheal extubation in operating room after single-lung transplantation

    摘要
  • 摘要:
      目的  探讨终末期慢性阻塞性肺疾病(COPD)患者单肺移植术后手术室内气管拔管方案的可行性及安全性。
      方法  回顾性分析57例因终末期COPD行单肺移植的受者的临床资料，根据本院制定的手术室内气管拔管评估指标进行评估，符合条件、在手术室完成气管拔管的为手术室拔管组(OR拔管组，17例)，在重症监护室(ICU)完成气管拔管的为ICU拔管组(40例)。比较两组术中气管拔管评估结果和术后康复情况。
      结果  与ICU拔管组比较，OR拔管组受者的氧合指数较高，动脉血二氧化碳分压(PaCO2)、血乳酸水平较低，血压波动幅度较小，术中使用体外膜肺氧合(ECMO)的例数较少(均为P < 0.05)。OR拔管组2例受者分别于返回ICU 6、8 h再次气管插管，术后6、9 d拔除气管导管。OR拔管组受者术后机械通气时间、术后ICU入住时间、术后住院时间均较ICU拔管组受者短(均为P < 0.05)。两组受者术后原发性移植物功能障碍(PGD)3级、房性快速性心律失常、连续肾脏替代治疗例数和1年生存率比较，差异均无统计学意义(均为P > 0.05)。
      结论  本院制定的COPD患者单肺移植术后手术室内气管拔管方案安全可行，可减少受者术后机械通气时间，缩短术后ICU入住时间及住院时间，不增加并发症发生率。

     

    Abstract:
      Objective  To evaluate the feasibility and safety of tracheal extubation in operating room for patients with end-stage chronic obstructive pulmonary disease (COPD) after single-lung transplantation.
      Methods  Clinical data of 57 recipients who underwent single-lung transplantation due to end-stage COPD were retrospectively analyzed. According to the evaluation indexes of tracheal extubation in operating room established by our hospital, 17 recipients eligible for tracheal extubation in operating room were assigned into the operating room extubation group (OR extubation group) and 40 recipients receiving tracheal extubation in intensive care unit (ICU) were allocated in the ICU extubation group. The evaluation results of intraoperative tracheal extubation and postoperative recovery were compared between two groups.
      Results  Compared with the ICU extubation group, recipients in the OR extubation group had higher oxygenation index, lower arterial partial pressure of carbon dioxide (PaCO2), lower blood lactic acid level, less fluctuation range of blood pressure and fewer cases receiving extracorporeal membrane oxygenation (ECMO) during operation (all P < 0.05). Two recipients in the OR extubation group received repeated tracheal intubation at 6 and 8 h after returning to ICU, and tracheal extubation at postoperative 6 and 9 d. In the OR extubation group, time of postoperative mechanical ventilation, length of postoperative ICU and hospital stay of the recipients were shorter than those in the ICU extubation group (all P < 0.05). The incidence of grade 3 primary graft dysfunction (PGD), atrial tachyarrhythmia, continuous renal replacement therapy and 1-year survival rate did not significantly differ between two groups (all P > 0.05).
      Conclusions  The tracheal extubation regimen in the operating room for COPD patients after single-lung transplantation established by our hospital is safe and feasible, which shortens the time of postoperative mechanical ventilation, the length of postoperative ICU and hospital stay, whereas does not increase the incidence of postoperative complications.

     

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