肺移植受者术后肺功能的变化特点

Changes of postoperative pulmonary function in lung transplant recipients

    摘要
  • 摘要:
      目的   分析肺移植受者术后肺功能的变化特点。
      方法   收集81例行双肺移植及心肺联合移植受者的临床资料，分析受者术后一般情况。分析肺移植受者术后1个月、3个月、每3个月（术后3~18个月）以及每6个月（术后18~36个月）肺通气及弥散功能指标。分析受者术后的最佳肺功能特点。
      结果   受者术后机械通气时间为4（2，9）d，术后重症监护室入住时间为10（7，20）d。81例受者中，27例术后发生原发性移植物功能障碍（PGD），发生率为33%。受者术后用力肺活量（FVC）占预计值百分比（FVC%pred）、第1秒用力呼气容积（FEV1）占预计值百分比（FEV1%pred）、FEV1/FVC占预计值百分比（FEV1/FVC%pred）、校正后肺一氧化碳弥散功能占预计值百分比（DLCOc%pred）随时间发生变化（均为P<0.001）。FVC%pred、FEV1%pred在术后9个月内逐渐上升，DLCOc%pred在术后3个月内逐渐上升（均为P<0.05）。FVC%pred≥80%者36例，FEV1%pred≥80%者41例，FEV1/FVC%pred≥92%者76例；FVC%pred≤40%者1例，FEV1%pred≤40%者1例。DLCOc%pred≥80%者16例，校正后肺一氧化碳弥散功能/肺泡容量占预计值百分比（DLCOc/VA%pred）≥80%者63例；DLCOc%pred≤40%者4例，DLCOc/VA%pred≤40%者1例。原发病为阻塞性肺疾病的受者术后FVC%pred、FEV1/FVC%pred、DLCOc%pred均高于原发病为限制性肺疾病的受者（均为P<0.05）。发生PGD的受者术后DLCOc%pred低于未发生PGD的受者（P<0.05）。
      结论   肺移植受者肺通气功能在术后9个月达到最佳状态且达到稳态，肺弥散功能在术后3个月达到稳态，原发病以及是否发生PGD可能对术后肺功能存在影响。

     

    Abstract:
      Objective  To analyze the changes of postoperative pulmonary function in lung transplant recipients.
      Methods  Clinical data of 81 recipients undergoing bilateral lung transplantation and combined heart-lung transplantation were collected, and postoperative status of the recipients was analyzed. Pulmonary ventilation and diffusion function indexes at 1 month, 3 months, every 3 months (3-18 months after lung transplantation) and every 6 months (18-36 months after lung transplantation) were analyzed in the recipients. The characteristics of the optimal pulmonary function in the recipients were assessed.
      Results  Postoperative mechanical ventilation time was 4 (2, 9) d, and the length of postoperative ICU stay was 10 (7, 20) d. Among 81 recipients, 27 recipients developed primary graft dysfunction (PGD) after lung transplantation, with an incidence rate of 33%. Postoperative forced vital capacity (FVC) to predicted value ratio (FVC%pred), forced expiratory volume in one second (FEV1) to predicted value ratio (FEV1%pred), FEV1/FVC to predicted value ratio (FEV1/FVC%pred) and corrected diffusion lung capacity for CO to predicted value ratio (DLCOc%pred) were changed over time (all P<0.001). FVC%pred and FEV1%pred were gradually increased within postoperative 9 months, and DLCOc%pred was gradually elevated within postoperative 3 months (all P<0.05). Thirty-six recipients had FVC%pred≥80%, FEV1%pred≥80% in 41 cases, FEV1/FVC%pred≥92% in 76 cases, FVC%pred≤40% in 1 case and FEV1%pred≤40% in 1 case, respectively. Sixteen recipients had DLCOc%pred≥80%, corrected diffusion lung capacity for CO/alveolar volume to predicted value ratio (DLCOc/VA%pred) ≥80% in 63 cases, DLCOc%pred≤40% in 4 cases and DLCOc/VA%pred≤40% in 1 case, respectively. Postoperative FVC%pred, FEV1/FVC%pred and DLCOc%pred in recipients with a primary disease of obstructive pulmonary disease were significantly higher than those in their counterparts with restrictive pulmonary disease (all P<0.05). Postoperative DLCOc%pred in recipients with PGD was significantly lower than that in those without PGD (P<0.05).
      Conclusions  Pulmonary ventilation function in lung transplant recipients reaches the optimal state and maintains a steady state at postoperative 9 months, and pulmonary diffusion function reaches a steady state at postoperative 3 months. Primary diseases and the incidence of PGD may affect postoperative pulmonary function.

     

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