终末期肺动脉高压患者肺移植术后心功能恢复情况总结及分析  

Summary and analysis of cardiac function recovery in patients with end-stage pulmonary arterial hypertension after lung transplantation

作　　者：邢斌[1] 赵丽[1] 郭丽娟 李敏[2] 顾思超[2] 梁朝阳[3] 苏昆松 陈文慧[1] Xing Bin;Zhao Li;Guo Lijuan;Li Min;Gu Sichao;Liang Chaoyang;Su Kunsong;Chen Wenhui(Department of lung transplantation,Center of respiratory medicine,China-Japan Friendship Hospital,Beijing 100029,China;Department of pulmonary and critical care medicine,Center of respiratory medicine,China-Japan Friendship Hospital,Beijing 100029,China;Department of thoracic surgery,Center of respiratory medicine,China-Japan Friendship Hospital,Beijing 100029,China.)

机构地区：[1]中日友好医院呼吸中心,肺移植科,北京100029 [2]中日友好医院呼吸中心,呼吸与危重症医学科,北京100029 [3]中日友好医院呼吸中心,胸外科,北京100029

出　　处：《实用器官移植电子杂志》2025年第2期141-146,共6页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：中国医学科学院医学与健康科技创新工程项目(2021-I2M-1-049);国家高水平医院临床科研经费(2022-NHLHCRF-LX-01)。

摘　　要：目的通过对终末期肺动脉高压肺移植患者术前及术后临床资料的回顾性总结,分析患者术后心功能的恢复情况。方法回顾性分析2017年3月至2024年6月中日友好医院肺移植科收治的因终末期肺动脉高压接受肺移植治疗的患者共6例,分析了患者术前的一般资料、术前心功能、围手术期体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)及主动脉球囊反搏(intra-aortic balloon pump,IABP)应用、手术及术后心功能恢复情况。结果6例患者中男性3例,中位年龄为33.5岁,4例原发病为特发性肺动脉高压,2例原发病为艾森曼格综合征。所有患者术前均接受了详细的心功能评估。6例患者均接受了VA-ECMO辅助的双肺移植,ECMO辅助时间为2~7 d,中位时间为4 d。2例患者应用了IABP。术后3例患者出现了左心功能不全,经积极治疗,所有患者围手术期心功能均得以恢复。术后心脏超声结果显示,患者术后心脏超声相关指标均恢复正常,与术前相比均有统计学差异(P<0.05)。结论双肺移植是终末期肺动脉高压患者最后的治疗选择,围手术期VA-ECMO及IABP等循环支持手段有助于术后患者心功能的恢复。Objective To retrospectively summarize the perioperative clinical data of patients with endstage pulmonary arterial hypertension undergoing lung transplantation,and to analyze the recovery of cardiac function after surgery.Methods A retrospective analysis was conducted on six patients with end-stage pulmonary arterial hypertension who underwent lung transplantation at the Department of Lung Transplantation of China-Japan Friendship Hospital from March 2017 to June 2024.The general information of the patients before surgery,preoperative cardiac function,perioperative use of ECMO and IABP,and the recovery of cardiac function after surgery were analyzed.Results Among the six patients,three were male,and the median age was 33.5 years old.Four patients were diagnosed with idiopathic pulmonary arterial hypertension,and two had Eisenmenger's syndrome.All patients underwent a detailed cardiac function assessment before surgery.All six patients underwent double lung transplantation with VA-ECMO assistance.The duration of ECMO assistance was 2~7 d,with a median time of 4 d.Two patients used IABP.Three patients developed left heart dysfunction after the surgery.But after effective treatment,all patients'cardiac function recovered during the perioperative period.Postoperative echocardiographic results showed that the relevant indicators of cardiac function of all the patients returned to normal,with statistically significant differences compared to preoperative levels(P<0.05).Conclusion Double lung transplantation is the last treatment option for patients with end-stage pulmonary arterial hypertension.Perioperative circulatory support measures,such as VA-ECMO and IABP,are beneficial for the recovery of cardiac function in such patients.

关 键 词：肺动脉高压 肺移植 心功能 体外膜肺氧合 

分 类 号：R655.3[医药卫生—外科学]