特发性肺纤维化合并不同程度肺动脉高压对肺移植早期预后的影响  

Effect of idiopathic pulmonary fibrosis combined with different degrees of pulmonary hypertension on the early prognosis of lung transplantation

作　　者：胡春兰 刘民强[2] 王净 于慧智 顾思佳 秦钟 李小杉 陈静瑜 胡春晓 Hu Chunlan;Liu Minqiang;Wang Jing;Yu Huizhi;Gu Sijia;Qin Zhong;Li Xiaoshan;Chen Jingyu;Hu Chunxiao(Department of Anesthesiology,The Affiliated Wuxi People’s Hospital of Nanjing Medical University,Wuxi 214023,China;Department of Anesthesiology,Shenzhen Third People’s Hospital,Shenzhen 518112,China;Department of Lung Transplantation Center,The Affiliated Wuxi People’s Hospital of Nanjing Medical University,Wuxi 214023,China)

机构地区：[1]南京医科大学附属无锡人民医院麻醉科,无锡214023 [2]深圳市第三人民医院麻醉科,深圳518112 [3]南京医科大学附属无锡人民医院肺移植中心,无锡214023

出　　处：《中华胸心血管外科杂志》2022年第11期646-654,共9页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(8207011015);无锡市科技发展计划项目(N20202029)。

摘　　要：目的探究特发性肺纤维化(idiopathic pulmonary fibrosis,IPF)患者合并不同程度肺动脉高压(pulmonary arterial hypertension,PAH)对肺移植(lung transplantation,LTx)术后患者早期预后的影响。方法回顾性分析2017年1月至2020年12月在无锡市人民医院接受LTx的134例IPF合并PAH患者临床资料,根据术前右心导管检测的平均肺动脉压力,将病例分为轻度PAH组(63例)、中度PAH组(47例)、重度PAH组(24例),收集3组供体资料以及受体术前、术中及术后相关资料并进行生存分析,比较3组患者术后早期的预后情况。结果伴随肺动脉压力升高,患者右心功能异常比率升高,术前左心室舒张末期内径减少比例增多,术中采用静脉-动脉体外膜肺氧合(veno-arterial extracorporeal membrane oxygenation,V-A ECMO)的比率增加(P<0.05)。多因素分析发现,合并重度PAH对LTx术后原发性移植物功能障碍(primary graft dysfunction,PGD)、再次气管插管或气管切开、72 h内低血容量性休克以及6个月生存率影响显著。生存曲线提示,IPF患者合并轻度、中度、重度PAH时LTx术后30天生存率分别为85.7%、80.8%、66.7%,术后6个月生存率分别为80.9%、74.0%、62.2%。结论IPF患者合并不同程度PAH对术前心功能及LTx期间ECMO选择的影响显著,合并重度PAH时可明显降低LTx术后早期生存率。Objective To explore the early prognosis on patient of idiopathic pulmonary fibrosis(IPF)combined with different degrees of pulmonary arterial hypertension(PAH)undertake lung transplantation(LTx).Methods From January 2017 to December 2020,the clinical data of 134 patients with IPF who underwent LTx in Wuxi People's Hospital were analyzed retrospectively.According to the average pulmonary artery pressure detected by right cardiac catheter before operation,the patients were divided into mild PAH group(63 cases),moderate PAH group(47 cases)and severe PAH group(24 cases).The donor data and the recipient's preoperative,intraoperative and postoperative data were collected;the postoperative survival curve to analyze early survival among the three patient groups.Results With the increase of pulmonary artery pressure,the rate of abnormal right ventricular function increased,the end diastolic diameter of left ventricle decreased before operation,and the rate of using veno-arterial extracorporeal membrane oxygenation(V-A ECMO)increased during the surgery(P<0.05).Multivariate analysis found that combined severe PAH had significant effects on primary graft dysfunction(Primary graft dysfunction,PGD),retracheal intubation or tracheotomy,hypovolemic shock within 72 h,and 6-month survival after LTx.The survival surve showed that 30-day survival rates of patients with IPF complicated with mild,moderate and severe PAH were 85.7%,80.8%and 66.7%respectively,and the 6-month survival rates were 80.9%,74.0%and 62.2%,respectively.Conclusion Patient of IPF combined with different degrees of PAH had a significant impact on cardiac function and intraoperative ECMO selection of LTx,and severe PAH could significantly reduce the early survival rate after LTx.

关 键 词：特发性肺纤维化 肺移植 肺动脉高压 

分 类 号：R655.3[医药卫生—外科学]