ECMO在肺纤维化合并肺气肿受者肺移植术中的临床应用效果  

Clinical application effect of ECMO in lung transplantation for recipients with combined pulmonary fibrosis andemphysema

作　　者：梁佳龙 周锦涛 陈静瑜 陈员 叶书高 Liang Jialong;Zhou Jintao;Chen Jingyu;Chen Yuan;Ye Shugao(Wuxi Medical Center,Nanjing Medical University,Wuxi People's Hospital,Lung Transplant Center,the Affiliated Wuxi People's Hospital of Nanjing Medical University,Wuxi 214023,China)

机构地区：[1]南京医科大学无锡医学中心无锡市人民医院南京医科大学附属无锡人民医院肺移植中心,江苏无锡214023

出　　处：《器官移植》2024年第6期935-941,共7页Organ Transplantation

基　　金：国家自然科学基金(82070059);江苏省医学创新中心项目(CXZX2022001)。

摘　　要：目的探讨肺移植术中不同体外膜肺氧合(ECMO)转流方式对肺纤维化合并肺气肿(CPFE)患者预后的影响。方法回顾性分析44例接受肺移植的CPFE患者,并将其分为静脉-静脉ECMO(VV-ECMO)组(30例)和静脉-动脉ECMO(VA-ECMO)组(14例)。比较两组患者术前、术中、术后及随访相关指标。结果与VV-ECMO组比较,VA-ECMO组患者年龄较小,术前肺动脉压力较高,后外侧切口类型较少,手术时间较长,术后支气管胸膜瘘发生率较高(均为P<0.05)。两组术后肺动脉压力均下降,且VA-ECMO组下降幅度较大(P<0.05)。两组术后生存率差异无统计学意义(P>0.05)。结论VA-ECMO和VV-ECMO应用于CPFE患者肺移植术中均安全有效,转流方式对患者的短中期预后无显著影响,其中VA-ECMO更适用于术前肺动脉压较高的患者。Objective To investigate the effects of different extracorporeal membrane oxygenation(ECMO)bypass modes on the prognosis of patients with combined pulmonary fibrosis and emphysema(CPFE)during lungtransplantation.Methods A retrospective analysis was conducted on 44 CPFE patients who underwent lungtransplantation,and they were divided into the venous-venous ECMO(VV-ECMO)group(30 cases)and the venous-arterial ECMO(VA-ECMO)group(14 cases).The preoperative,intraoperative,postoperative and follow-up relatedindicators of two groups were compared.Results Compared with the VV-ECMO group,the patients in the VA-ECMOgroup were younger,had higher pulmonary artery pressure before surgery,fewer posterolateral incision types,longeroperation times,and higher incidence of postoperative bronchopleural fistula(all P<0.05).The pulmonary artery pressuredecreased after surgery in both groups,with a greater decrease in the VA-ECMO group(P<0.05).There was nostatistically significant difference in postoperative survival rates between the two groups(P>0.05).Conclusions Both VA-ECMO and VV-ECMO are safe and effective in lung transplant patients with CPFE.The bypass mode has no significantimpact on the short and medium-term prognosis of the patients.VA-ECMO is more suitable for patients with higherpreoperative pulmonary artery pressure.

关 键 词：肺移植 特发性肺纤维化 肺气肿 体外膜肺氧合 静脉 动脉 肺动脉高压 并发症 

分 类 号：R617[医药卫生—外科学] R563[医药卫生—临床医学]