肺移植治疗良性终末期肺病受者术后1年内生存的危险因素分析  

Risk factors analysis for 1-year postoperative survival of patients with benign end-stage lung diseases after lung transplantation

作　　者：许红阳 王大鹏 姜淑云 张锋 高嵩 陈耿靖 陈静瑜 Xu Hongyang;Wang Dapeng;Jiang Shuyun;Zhang Feng;Gao Song;Chen Gengjing;Chen Jingyu(Department of Critical Care Medicine,Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi 214023,Jiangsu,China;Department of Thoracic Surgery,Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi 214023,Jiangsu,China)

机构地区：[1]南京医科大学附属无锡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人民医院胸外科,江苏无锡214023

出　　处：《中华危重病急救医学》2021年第7期832-837,共6页Chinese Critical Care Medicine

基　　金：江苏省无锡市科技发展指导性计划项目(CSZON1701)。

摘　　要：目的探讨肺移植治疗良性终末期肺病受者术后1年内出现的主要并发症、死亡原因及影响生存的危险因素。方法采用回顾性研究方法,分析南京医科大学附属无锡人民医院肺移植工作组2017年5月至2018年10月完成的200例良性终末期肺病肺移植受者的临床资料。分析受者术后1年内出现的主要并发症、存活情况及死亡原因;采用Kaplan-Meier法绘制生存曲线,采用Log-Rank检验分析受者的性别、边缘性供肺、原发病类型、术前合并中重度肺动脉高压(PAH)、术中应用体外膜肺氧合(ECMO)支持、手术方式、术中大量失血、术后并发症〔感染、原发性移植物失功(PGD)、急性排斥反应〕对受者术后存活情况的影响;采用多因素Cox比例风险回归模型分析受者术后1年内死亡的独立危险因素。结果200例受者均顺利完成肺移植,术后1年内出现的并发症为感染131例、PGD 20例、急性排斥反应57例、吻合口并发症26例、其他(如新发糖尿病、骨质疏松等)53例。受者术后3个月、6个月、1年的累积生存率分别为81.5%、80.0%和77.5%。共有45例受者在术后1年内死亡,死亡原因包括感染14例、PGD 7例、急性排斥反应8例、吻合口并发症4例、心脑血管意外3例、多器官功能衰竭3例、呼吸功能衰竭2例、其他(如交通意外等)4例。Kaplan-Meier生存分析显示,受者的性别、原发病为特发性肺纤维化(IPF)、术前合并中重度PAH、术中应用ECMO支持、术中大量失血以及术后发生感染、PGD和急性排斥反应是影响受者术后1年内存活的主要因素。多因素Cox回归模型分析显示,受者为男性是保护性因素〔风险比(HR)=0.481,95%可信区间(95%CI)为0.244~0.947,P=0.034〕,原发病为IPF(HR=2.667,95%CI为1.222~5.848,P=0.014)、术中应用ECMO支持(HR=1.538,95%CI为0.787~3.012,P=0.028)、术中大量失血(HR=2.026,95%CI为0.976~4.205,P=0.045)以及术后发生感染(HR=3.138,95%CI为1.294~7.608,P=0Objective To investigate the main postoperative complications,causes of death and the risk factors for survival in patient with benign end-stage lung diseases within 1 year after lung transplantation.Methods A retrospective analysis was conducted to collect the clinical data of 200 patients with benign end-stage lung disease who underwent lung transplantation admitted to Wuxi People's Hospital Affiliated to Nanjing Medical University from May 2017 to October 2018.The main postoperative complications,survival and causes of death within 1 year after operation were analyzed.The Kaplan-Meier method was used to plot survival curves,and the Log-Rank test was used to compare the influence of factors,including recipient's gender,use of marginal donor lung,primary disease,preoperative combination of moderate to severe pulmonary hypertension(PAH),intraoperative extracorporeal membrane oxygenation(ECMO)support,surgical methods,intraoperative massive blood loss,postoperative complications[infection,primary graft dysfunction(PGD),acute rejection],on 1-year survival in patients who underwent lung transplantation.The multivariate Cox proportional hazards regression model was used to evaluate the risk factors of death within 1 year after lung transplantation.Results Two hundred patients underwent successful lung transplantation.The major postoperative complications within 1 year after transplantation included infection in 131 patients,PGD in 20 patients,acute rejection in 57 patients,anastomotic complication in 26 patients and others(new onset diabetes,osteoporosis,etc.)in 53 patients.The 3-month,6-month,and 1-year postoperative cumulative survival rates were 81.5%,80.0%and 77.5%,respectively.Forty-five patients died during 1 year after operation,among whom 14 died of infection,7 died of PGD,8 died of acute rejection,4 died of anastomotic complication,3 died of cardio-cerebrovascular accident,3 died of multiple organ failure,2 died of respiratory failure and 4 died of other causes(traffic accident,etc.).The Kaplan-Meier survival

关 键 词：肺移植 并发症 危险因素 

分 类 号：R655.3[医药卫生—外科学]