肺移植术治疗终末期支气管扩张症7例临床分析  

Lung transplantation for end-stage bronchiectasis in 7 cases

作　　者：赵凯 王跃斌[1] 丁志丹[1] 刘峰辉[2] 杨睿[2] 冯敏[3] 金峰[4] 黄明君[5] 夏宗江[1] 赵高峰[1] ZHAO Kai;WANG Yue-bin;DING Zhi-dan;LIU Feng-hui;YANG Rui;FENG Min;JIN Feng;HUANG Ming-jun;XIA Zong-jiang;ZHAO Gao-feng(Department of Thoracic Surgery and Lung Transplantation Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Respiratory Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Critical Care Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Anesthesiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Cardiovascular Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第一附属医院胸外科/肺移植外科,河南郑州450052 [2]郑州大学第一附属医院呼吸内科,河南郑州450052 [3]郑州大学第一附属医院重症医学科,河南郑州450052 [4]郑州大学第一附属医院麻醉科,河南郑州450052 [5]郑州大学第一附属医院心血管外科,河南郑州450052

出　　处：《中华实用诊断与治疗杂志》2023年第5期433-437,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省高等学校重点科研项目(20A320059)。

摘　　要：目的 探讨终末期支气管扩张症患者行肺移植术治疗的效果。方法 回顾性分析7例行肺移植术的终末期支气管扩张症患者的临床资料。7例术前均行胸部CT、痰培养、6 min步行试验;术中术后采用保护性通气策略、早期液体负平衡管理、抗感染、抗排异、早期肺康复运动训练等治疗措施。记录肺移植术式、围术期情况;比较肺移植术前及术后动脉血气达稳定期时pa(CO_(2))、肺动脉收缩压。随访至2022年11月30日,记录患者生存情况。结果 (1)6例术前胸部CT影像表现为双肺弥漫性支气管扩张,1例左肺弥漫性支气管扩张、右上肺叶未见明显支气管扩张;7例痰培养均检出铜绿假单胞菌,其中3例检出多种病原菌;7例6 min步行试验均未完成。(2)4例行双肺移植术,1例行双侧肺叶移植术,1例行右肺移植+左侧肺叶移植术,1例行左肺移植+右肺中下叶切除术,手术时间270~510(373±85) min,住院时间29(16,45) d。单肺移植或双肺移植者第一侧供肺冷缺血时间330~510(429±66) min,双肺移植者第二侧肺冷缺血时间450~750(590±110) min。5例术前先建立体外膜肺氧合者中4例术后13.5(11.0,17.0)h顺利撤机,1例因围术期原发性移植物失功、脓毒血症、凝血功能异常死亡。5例术中输注红细胞6(2,26)u。5例术后20(14,40)h顺利拔出气管插管,2例脱机后pa(CO_(2))升高,再次气管插管后好转。6例患者病情好转出院。(3)7例术后动脉血气达稳定期时pa(CO_(2))[42(40,50) mm Hg]、肺动脉收缩压[(25±6)mm Hg]均明显低于术前[60(42,80),(46±20)mm Hg](Z=2.371,P=0.018;t=2.690,P=0.036)。(4)随访至2022年11月30日,1例术后3个月死于肺部多重耐药菌感染,1例术后24个月死于耶氏肺孢子菌感染和闭塞性细支气管炎,余4例生存状况良好。结论 终末期支气管扩张症患者常合并铜绿假单胞菌感染,加强肺移植术中气道开放、支气管吻合期间无菌保护、围术期管理,可延长生�Objective To investigate the outcome of lung transplantation for end-stage bronchiectasis.Methods The clinical data of 7patients with end-stage bronchiectasis undergoing lung transplantation were retrospectively analyzed.All7patients underwent chest CT,sputum culture and 6-min walk test before operation,and received protective ventilation strategy,early fluid negative balance management,anti-infection,anti-rejection,early pulmonary rehabilitation exercise and other therapeutic measures during and after operation.The operative procedures and perioperative conditions of lung transplantation were recorded.The pa(CO_(2))and the pulmonary artery systolic pressure were compared before operation and when the arterial blood gas was stable after operation.The patients were followed up till November 30,2022,to record the survival.Results(1)Before operation,the chest CT imaging showed diffuse bronchiectasis in both lungs in 6patients,and diffuse bronchiectasis in the left lung and no obvious bronchiectasis in the right upper lobe in 1patient;the sputum culture detected Pseudomonas aeruginosain all 7patients,in which 3patients were detected multiple pathogenic bacteria;no patient fulfilled 6-min walk test.(2)In 7patients,4 were performed double-lung transplantation,1 was performed bilateral lobe transplantation,1was performed right lung transplantation+left lobe transplantation,and 1was performed left lung transplantation+right middle and lower lobe resection.The operation lasted for 270to510(373±85)min,and the length of hospital stay was 29(16,45)days.The cold ischemia duration of single lung transplantation or the first transplanted donor lung in double lung transplantation was 330to 510(429±66)min,and the cold ischemia duration of the second transplantated donor lung in double-lung transplantation was 450 to750(590±110)min.Extracorporeal membrane oxygenation was assisted in 5patients during operation,in which 4patients got successful withdrawal in 13.5(11.0,17.0)h after operation,and 1 patient died of primary graft dys

关 键 词：支气管扩张症 终末期 肺移植术 

分 类 号：R655.3[医药卫生—外科学]