动脉肺泡氧分压比对肺移植术后机械通气延长的预测价值  

The predictive value of arterial alveolar oxygen partial pressure ratio in prolonged mechanical ventilation after lung transplantation

作　　者：董妍 王宋 田静 徐忠平 许红阳 Dong Yan;Wang Song;Tian Jing;Xu Zhongping;Xu Hongyang(Department of Critical Care Medicine,the Affiliated Wuxi People's Hospital of Nanjing Medical University,Wuxi People's Hospital,Wuxi Medical Center,Nanjing Medical University,Jiangsu Wuxi 214000,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214000

出　　处：《实用器官移植电子杂志》2025年第1期28-33,共6页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：2020年度无锡市卫生健康委科研项目青年项目(Q202054);2021年度无锡市“太湖人才计划”高端医学专家团队(2021THRC-TD-ZZYXK-2021)。

摘　　要：目的探讨动脉肺泡氧分压比[arterial-alveolar oxygen partial pressure ratio,P(a/A)O_(2)]对肺移植术后延迟脱机(prolonged mechanical ventilation,PMV)的预测价值并构建预测模型。方法回顾性分析在南京医科大学附属无锡人民医院2022年1月至2022年12月间152例首次行肺移植并接受静脉-静脉体外膜肺氧合支持手术患者的临床资料。根据术后有创机械通气时间分为机械通气延长PMV组(通气时间>48 h,91例)和对照组(通气时间≤48 h,61例)。比较患者术中指标(手术方式、手术时间和供肺冷缺血时间),入重症监护病房(intensive care unit,ICU)即刻、8 h、24 h、48 h的动脉血气分析结果,记录血红蛋白(hemoglobin,Hb)、二氧化碳分压(partial pressure of carbondi oxide,PaCO_(2))、实际碳酸氢根HCO_(3)^(-)、乳酸(lactic acid,Lac)、肺泡-动脉氧分压差[difference of alveoli-arterial oxygen pressure,P(A-a)O_(2)、P(a/A)O_(2)、氧合指数(oxygenation index,OI=PaO_(2)/FiO_(2))]、机械通气时间和ICU住院时间。采用受试者工作特征(receiver operating characteristic,ROC)曲线、Pearson相关性分析和多因素Logistic层次回归分析对结果变量进行分析。结果①P(a/A)O_(2)与氧合指数两者之间呈明显正相关关系(P<0.001)。②入ICU 8 h后的P(a/A)O_(2)对肺移植术后PMV具有良好的预测性能(敏感性、特异性分别为0.75、0.7,AUC为0.77)。③入ICU即刻氧合指数、入ICU 8 h后PaCO_(2)、HCO_(3)^(-),Lac,P(a/A)O_(2)是肺移植术后PMV独立危险因素。结论入ICU 8 h P(a/A)O_(2)是肺移植术后机械通气时间延长的独立危险因素,不应忽视P(a/A)O_(2)的动态变化,持续监测P(a/A)O_(2)有助于指导临床评估肺移植术后机械通气延长。Objective To investigate the predictive value of arterial alveolar oxygen partial pressure ratio in prolonged mechanical ventilation(PMV)after lung transplantation and to construct a predictive model.Methods A retrospective analysis was conducted on the clinical data of 152 patients who underwent their first lung transplant and received intravenous venous extracorporeal membrane oxygenation support surgery at the Affiliated Wuxi People's Hospital of Nanjing Medical University from January 2022 to December 2022.According to the duration of invasive mechanical ventilation after operation,all recipients were divided into the PMV group(ventilation duration>48 h,n=91)and control group(ventilation duration≤48 h,n=61).Perioperative indexes were compared between two groups,including intraoperative indexes(operation time,operation methods and cold ischemia time of donor lung)and postoperative indexes〔Hb,PaCO_(2),HCO_(3)^(-),lactate,P(A-a)O_(2),P(a/A)O_(2),and PaO_(2)/FiO_(2) at 0,8,24 h and 48 h after operation,mechanical ventilation time and intensive care unit(ICU)hospitalization time〕.Receiver operating characteristic(ROC)curve,Pearson correlation analysis and multivariate logistic regression analysis were used to analyze the outcome variables.Results①There was a significant positive correlation between P(a/A)O_(2) and PaO_(2)/FiO_(2)(P<0.001).②P(a/A)O_(2) at 8 h after ICU had a good predictive ability for PMV after lung transplantation(sensitivity and specificity were 0.750 and 0.700,AUC was 0.77).③PaO_(2)/FiO_(2) immediately after ICU admission,PaCO_(2) at 8 h after ICU admission,actual HCO_(3)^(-),lactate and P(a/A)O_(2) were independent risk factors for PMV after lung transplantation.Conclusion P(a/A)O_(2) is an independent risk factor for PMV after lung transplantation,and the dynamic changes of P(a/A)O_(2) should not be ignored.Continuous monitoring of P(a/A)O_(2) is helpful to guide clinical evaluation of prolonged mechanical ventilation after lung transplantation.

关 键 词：肺移植 动脉肺泡氧分压比 机械通气 

分 类 号：R47[医药卫生—护理学]