ABO血型不同的同种异体肺移植患者的临床处理及救治体会  

Clinical treatment and experience of treating allogeneic lung transplantation with different ABO blood groups

作　　者：周巍[1] 孔祥荣[1] 王凯[1] 刘蕾[1] 柴军武[1] 陈洪磊[1] 薛奋龙 

机构地区：[1]天津市第一中心医院心外科,天津市器官移植临床研究中心,300192

出　　处：《天津医药》2018年第1期74-76,共3页Tianjin Medical Journal

基　　金：国家国际科技合作专项项目(2015DFG31850);天津市科技计划项目(14RCGFSY00147)

摘　　要：目的总结ABO血型不同但相容的同种异体肺移植患者的临床处理经验。方法回顾性分析2015年8月—9月天津市第一中心医院心外科完成的3例ABO血型不同但相容肺移植手术过程。3例供体均为脑死亡患者,ABO血型不同但相容,群体反应性抗体(PRA)及淋巴细胞毒交叉配合试验均为阴性。手术方式为左单肺移植和序贯式双肺移植。移植术后予以常规治疗肺水肿、免疫抑制(吗替麦考酚酯+他克莫司+糖皮质激素的三联免疫抑制治疗)、抗感染(亚胺培南西司他丁钠+米卡芬净钠+更昔洛韦)等治疗。结果 3例受者均顺利完成手术,手术时间5~6h,冷缺血时间均小于4 h,术中出血量800~1 000 m L。3例患者术后24 h内拔除气管插管,胸腔闭式引流管在72 h内拔出,ICU停留时间5~8 d。术后第5周出院,2例术后第6天出现肺部感染,升级抗生素治疗3周后痊愈。术后随访21~22个月,3例均存活且未发生移植物排斥等严重并发症。结论全面有效的手术技术,合理的供肺选择及保护方法,积极的抗感染策略和三联免疫抑制方案可以提高移植术后早期存活率。Objective To summarize the clinical experience in the treatment of allogeneic lung transplantation withABO-different donor.MethodsData of three cases of lung transplantation carried out in Tianjin First Central Hospitalfrom August to September 2015 were retrospectively analysed. ABO blood groups were different but compatible in threedonors who were with brain death, and their panel reactive antibody(PRA) and lymphocyte poison cross matching test werenegative. The surgical approaches were left single-lung transplantation and sequential bilateral single-lung transplantation.After the surgery, measures for pneumonedema control, immuno suppression(mycophenolate mofetil + tacrolimus +glucocorticoids) and anti-infection(imipenem and cilastatin sodium + micafungin sodium + ganciclovir) were carried out.ResultsThe operation wsa completed successfully in all 3 patients, and the operative time was 5-6 hours. The coldischemia time was less than 4 hours. The blood loss during the operation was 800-1000 m L. The trachea cannula extubationwas pulled out within 24 h, thoracic drainage tube was pulled out within 72 h. All the patients were moved into general wardin 5-8 days. Patients discharged from hospital in 5 weeks after operation. Pneumonia infection occurred in 2 cases on the 6 th day after operation, and antibiotic treatment was upgraded and infection was cured after 3 weeks. All patients werefollowed up for 21-22 months, and 3 patients survived without serious complications such as graft rejection.Conclusion Comprehensive and effective surgical techniques, reasonable choice of donor lung and preservation method, active anti-infection strategy and triple immunosuppressive program can improve the survival rate after transplantation.

关 键 词：肺移植 手术期间 免疫抑制法 手术后并发症 ABO血型相容 抗感染 

分 类 号：R617[医药卫生—外科学]