术前肺动脉舒张压对特发性肺纤维化患者双肺移植术后原发性移植物失功的预测价值  

Value of preoperative pulmonary artery diastolic pressure on predicting primary graft dysfunction after bilateral lung transplantation for patients with idiopathic pulmonary fibrosis

作　　者：张锋[1] 许红阳[1] 姜淑云[1] 李家琼[4] 陆顺梅 王大鹏[1] 臧芝栋[1] 潘红[1] 陈静瑜[3] 

机构地区：[1]南京医科大学附属无锡市人民医院重症医学科,江苏无锡214023 [2]南京医科大学附属无锡市人民医院麻醉科,江苏无锡214023 [3]南京医科大学附属无锡市人民医院胸外科,江苏无锡214023 [4]徐州市中心医院重症医学科,江苏徐州221009

出　　处：《中华危重病急救医学》2017年第5期442-447,共6页Chinese Critical Care Medicine

基　　金：江苏省第四期“333工程”科研项目（BRA2013026）

摘　　要：目的分析特发性肺纤维化（IPF）患者双肺移植术后发生原发性移植物失功（PGD）的危险因素，探讨其对术后PGD的预测价值。方法采用回顾性分析方法，选择2014年6月至2017年3月在南京医科大学附属无锡市人民医院行双肺移植术的58例IPF患者为研究对象。终点事件为移植术后3d内发生3级PGD，将患者分为PGD组和非PGD组。收集患者性别、年龄、体质指数（BMI）、基础疾病、术前N端脑钠肽前体（NT—proBNP），术前和术后肺动脉收缩压（PASP）、肺动脉舒张压（PADP）、平均肺动脉压（mPAP），手术时间，术中和术后输血情况，术中是否应用体外膜肺氧合（ECMO），术后是否进行血液净化治疗，以及术后3d内休克的发生情况等。比较两组患者手术相关指标的差异，采用二分类logistic回归分析寻找PGD的独立预测因子；绘制受试者工作特征曲线（ROC），评估患者术前PADP对术后发生3级PGD的预测价值。结果58例接受肺移植患者中有6例因部分重要资料缺失予以剔除，最终共52例患者纳入分析。术后诊断为3级PGD患者17例，病死率47．06％；非PGD组35例，病死率8．57％。PGD组患者术前PADP和mPAP、术后悬浮红细胞用量及术中和术后总输血量均明显高于非PGD组[术前PADP（mmHg，1mmHg=0．133kPa）：33．7±10．5比25．3±10．1，术前mPAP（mmHg）：40．4±14．1比32．8±11．1，术后悬浮红细胞用量（mL）：700（300，1500）比300（300，500），术中和术后总输血量（mL）：2250（1850，4275）比1800（1550，2800），均P〈0．05]；而两组患者性别、年龄、BMI、基础疾病、术前NT—proBNP，术前和术后PASP、术后PADP和mPAP，手术时间，术中血浆、悬浮红细胞用量和总输血量，术后血浆用量、总输血量，术中和术后总血浆、总悬浮红细胞用量，术中应用ECMO，术后进行血液净化治疗，以及术后休克发生情况差异均Objective To analyze the value of the potential risk factors on predicting primary graft dysfunction （PGD） after bilateral lung transplantation for the patients with idiopathic pulmonary fibrosis （IPF）. Methods A retrospective study was conducted. Fifty-eight patients with IPF who underwent the bilateral lung transplantation admitted to Wuxi People＇s Hospital Affiliated to Nanjing Medical University from June 2014 to March 2017 were enrolled. The grade 3 PGD happened within 72 hours after transplantation was taken as the outcome event, and these patients were divided into PGD and non-PGD groups. The age, gender, body mass index （BMI）, underlying disease, and N-terminal-prohrain natriuretic peptide （NT-proBNP） before operation, pulmonary artery systolic pressure （PASP）, pulmonary artery diastolic pressure （PADP）, and mean puhnonary artery pressure （mPAP） before and after operation,duration of operation, the volume of blood transfusion during operation and postoperation, the use of extracorporeal membrane oxygenation （ECMO） during the operation, blood purification treatment after operation, and shock within 3 days after operation were recorded. The differences of parameters mentioned above between the two groups were compared. The predictive factors of PGD were searched by binary logistic regression analysis, and the receiver operating characteristic curve （ROC） was plotted to analyze the predictive value of preoperative PADP for grade 3 PGD after transplantation. Results Among 58 patients who underwent the bilateral lung transplantation, 52 patients were enrolled. The rest patients were excluded because of incomplete clinical data. There were 17 patients in the PGD group, with a mortality rate of 47.06%. The non-PGD group included 35 patients with a mortality rate of 8.57%. PADP and mPAP ahead of operation, the dosage of red cells suspension after the operation, and the total amount of blood transfusion during and after the operation in PGD group were significantly higher than

关 键 词：肺纤维化 特发性 移植物失功 原发性 肺移植术 肺动脉舒张压 

分 类 号：R655.3[医药卫生—外科学]