肺移植围术期ICU的监测与治疗

Intensive Care Aspects of Lung Transplantation.

目的探讨肺移植的围术期ICU的监测与治疗。方法2002年9月-2005年3月我院15例肺移植患者，其中9例为肺气肿、3例为肺纤维化、1例矽肺、1例肺血管平滑肌瘤病及1例室间隔缺损合并艾森曼格综合征患者。手术方式：左肺移植7例，右肺移植5例，室缺修补＋右肺移植1例，双肺移植2例。术后带管进入ICU行机械通气、免疫抑制治疗、预防感染和再灌注损伤等并发症。结果术后平均呼吸机脱机时间7天，平均ICU停留时间为10天。术后3例死亡，1例于术后15天死于急性排斥，1例子术后28天死于成人呼吸窘迫综合征（ARDS），1例术后36天死于肺梗死，12例恢复良好已痊愈出院，最长生存已达30个月。结论肺移植围术期的监测与治疗是肺移植手术成功和长期生存的关键。术后的缺血再灌损伤、排斥和感染仍屉肺移植短期死亡的主要原因。

Objective To evaluate the application of critical care aspects Lung Transplantation. Methods Since Sep 2002 until Mar 2005, we performed 15 cases of lung transplant recipients.of them, 9 cases were emphysema, 3 cases were pulmonary fibrosis, 1 case was pneumosilicosis, 1 case was pulmonary vascularleiomyoma, 1 case was ventricular septal defect and Eisenmenger＇ s syndrome. Operative technique： 7 cases were received left - lung transplantation, 5 cases were received right - lung transplantation, 1 case was right single lung transplantation and ventricular septal defect repair, and 2 cases were hilateral sequential lung transplantation. All the patients were received mechanical ventilation, inanunosuppressive agents, antibacterial prophylaxis, and prevention of reperfusion injury in ICU after operation. Results The average ICU admission time is 10 days, 3 cases were died, of whome, one was died of acute rejection at 15th day, the othe was died of ARDS at 28th day postoperation, and another was died of pulmonary embolism at 36th days after operation. 12 eases were recovered quickly and discharged from the hospital. One case has lived 30 months. Conclusion It is important that the ICU team has a working knowledge of the common complications, Mien thses complications are mostly like to occur and how best to treat them when they do arise.. It is associated with long - term survival and success. Ischemia - reperfusion in jury, rejection, infection are still main cause of early mortality.