肺移植术后胸腔引流量的变化规律及其与预后的关系  

Changes of thoracic drainage volume and their relationship with prognosis after lung transplantation

作　　者：陈其瑞[1] 侯生才[1] 胡滨[1] 李彤[1] 王洋[1] 苗劲柏[1] 游宾[1] 傅毅立[1] 张文谦[1] 陈硕[1] 胡晓星[1] 章智荣[1] 李辉[1] 

机构地区：[1]首都医科大学附属北京朝阳医院胸外科,北京100020

出　　处：《中华器官移植杂志》2017年第8期464-468,共5页Chinese Journal of Organ Transplantation

摘　　要：目的观察肺移植术后胸腔引流量的变化规律，并探讨影响因素及其对肺移植预后的影响。方法回顾性分析2005年至2016年期间完成的46例肺移植病例，统计每例受者术后胸腔引流量，分析其变化规律，对可能影响引流量的因素进行单因素分析，并对术后不同预后受者分组，比较引流量的差异。数据采用SPSS（19．0版）软件进行统计处理。结果所有46例受者中无术中死亡。术后胸腔引流时间为9．3d，胸腔总引流量为4318ml，平均每天引流量为487ml。围手术期应用体外循环或体外膜肺氧合的受者平均每天单侧胸腔引流量显著增加（P〈0．05）。肺移植术后1个月、3个月及1年死亡受者术后平均每天引流量及平均每天单侧胸腔引流量明显大于同期存活受者（P〈0．05）；术后3个月死亡受者胸腔引流总量明显高于存活受者（P〈0．05）；术后3年死亡受者平均每天单侧胸腔引流量明显高于存活受者（P〈0．05）。结论肺移植术后胸腔引流量较多预示受者短期预后不良。术中充分止血，围手术期慎用体外循环，以及严格掌握体外膜肺氧合的应用指证和时机是改善胸腔引流量的有效措施。Objective To observe the changes of thoracic drainage volume after lung transplantation, and to explore the influencing factors and their relationship with the prognosis of lung transplantation. Methods This retrospective analysis included 46 consecutive lung transplantations in our hospital betw.een 2005 and 2016. The volume of postoperative chest drainage was recorded and analyzed. Single factor analysis of the factors that may affect the drainage was done. The patients were divided into different groups according to different prognosis at different time points after operation, and drainage volume was compared araong groups. All analyses were performed with SPPS, version 19. 0. Results There were no operative deaths. The median thoracic drainage time was 9. 3 days, the median total thoracic drainage volume was 4318 mL, and the average daily drainage volume was 487 mL. During the perioperative period, the use of cardiopulmonary bypass or extracorporeal membrane oxygenation increased significantly the volume of unilateral pleural drainage （P〈0. 05）. The average daily drainage volume and the average daily unilateral pleural drainage volume in the postoperative dead patients were significantly greater than those of survivals at 1st month, 3rd month and 1st year after lung transplantation （P〈0. 05）. At 3rd month after transplantation, the total amount of postoperative thoracic drainage was significantly greater than that of survivals （P 〈 0. 05）. The average daily unilateral pleural drainage volume in dead patients after surgery was significantly greater than that of the survival patients 3 years after operation （P〈 0. 05）. Conclusion Intraoperative hemostasis in patients with lung transplantation should receive considerable attention, cardiopulmonary bypass and extracorporeal membrane oxygenation should be used cautiously during perioperative period, and greater postoperative chest drainage predicated poor short-term prognosis.

关 键 词：肺移植 胸腔引流 预后 

分 类 号：R655.3[医药卫生—外科学]