连续性肾脏替代治疗在肺移植边缘性供肺维护中的临床价值  

Study of the clinical value of continuous renal replacement therapy(CRRT) in the maintenance of marginal donor lungs

作　　者：黄健 尹攀 岳冰清 王梓涛 卫栋[1] 赵晋 陈静瑜[1,2] Huang Jian;Yin Pan;Yue Bingqing(Department of Lung Transplantation,the Affiliated Hospital of Nanjing Medical University,Wuxi,China)

机构地区：[1]江苏省无锡市肺移植中心,江苏省无锡市人民医院,214000 [2]浙江大学附属第二医院肺移植科

出　　处：《临床外科杂志》2022年第10期994-997,共4页Journal of Clinical Surgery

摘　　要：目的评价连续性肾脏替代治疗在边缘性供肺维护中的应用价值。方法2019年1月1日~2019年10月31日经无锡市人民医院肺移植中心维护的脑死亡边缘性供肺30例,根据维护方法不同,将其分为两组,实验组12例,在获取前予以常规+持续性肾脏替代治疗(CRRT)联合方案维护48小时;对照组18例,仅进行常规方案维护。两组每24小时留取外周血样,行胸片及气道纤支镜检查,动态监测并对比两种维护方式在血流动力学、氧合指数、感染指标、气道黏膜水肿以及供肺最终使用情况等的差异。结果经两种方法维护后,两组供肺质量均较前有不同程度改善,实验组和对照组氧合指数增加分别为(93.58±16.92)%和(57.72±11.41)%,C-反应蛋白(CRP)下降分别为(36.04±22.30)mg/L和(18.01±6.78)mg/L,降钙素原(PCT)下降分别为1.09±0.45和0.59±0.82,两组比较,差异有统计学意义(P<0.05)。实验组肺影像学的渗出改变、气道黏膜水肿程度改善显著。实验组中8例、对照组中5例达到供肺使用标准,实验组使用率显著高于对照组(P<0.05)。结论早期予以CRRT联合方案,能显著改善边缘性供肺肺功能,提高供体器官利用率。Objective To evaluate the value of continuous renal replacement therapy in the maintenance of marginal donor lungs.Methods A retrospective analysis of 30 marginal donor lungs maintained by the Lung Transplantation Center of Wuxi People’s Hospital from January 1,2019 to October 31,2019,of which 12 cases(set as the experimental group)received routine and CRRT combined program for 48 hours,and 18 cases(set as the control group)received routine maintenance.Peripheral blood samples were collected every 24 hours.Chest X-ray exam and airway bronchoscopy were performed in both groups.Results After maintenance by two methods,the quality of the donor lungs in both groups improved when compared with the previous ones.The oxygenation index in the experimental group was significantly higher than that in the control group[(93.58±16.92)%vs.(57.72±11.41)%,P<0.001)].The inflammatory indexes(CRP,PCT)were significantly decreased[(CRP:(36.04±22.30)mg/L vs.(18.01±6.78)mg/L,P<0.05];[PCT:(1.09±0.45)ng/L vs.(0.59±0.82)ng/L,P<0.05)].The exudation changes and airway mucosal edema in the experimental group were significantly improved.8 cases in the experimental group and 5 cases in the control group reached the donor criteria for transplant,and the utilization rate was significantly higher than that in the control group(P<0.05).Conclusion CRRT can significantly improve the lung function of marginal donor lungs and improve the utilization rate of donor organs.

关 键 词：连续性肾脏替代治疗 边缘性供肺 肺移植 

分 类 号：R655.3[医药卫生—外科学]