单肺移植治疗伴有肺动脉高压的终末期肺病

Single -lung transplantation for end -stage pulmonary parenchymai diseases with pulmonary hypertension

目的 观察单肺移植治疗对伴有肺动脉高压的终末期肺病患者的疗效。方法2002年9月—2005年11月我院22例单肺移植患者,其中肺气肿10例、肺纤维化10例、矽肺1例、肺淋巴管平滑肌瘤病1例。受体肺移植术前评估肺动脉压均显示有不同程度的升高。手术方式：左肺移植10例,右肺移植12例。术前常规心脏超声监测肺动脉收缩压,并通过动脉血气分析计算氧合指数（PaO2/FiO2）。结果 术后1周用Swan-Ganz导管测定患者平均肺动脉收缩压,较术前有明显下降,从（50.00±13.00）mmHg（1mmHg=0.133kPa）降至（39.50±7.36）mmHg（P〈0.05）;PaO2/FiO2明显改善,从（241.26±79.54）mmHg升到（348.23±99.31）mmHg（P〈0.05）。结论 单肺移植是治疗伴肺动脉高压终末期肺病的有效和可选方法。

Objective To observe the outcome of single -lung transplantation （SLT） for end -stage pulmonary parenchymal diseases in combination with pulmonary hypertension （PH）. Methods From September 2002 to November 2005, there were 22 lung transplantation recipients, suffering from emphysema （10/22）, pulmonary fibrosis （10/22）, pneumosilicosis （1/22）and vascular leiomyoma （1/22）, and all of them were complicated with pulmonary hypertension to different extent. Operative techniques.. 10 patients received left- lung transplantations, and 12 patients received right- lung transplantation. In all the patients echocardiography （ECHO） was performed before transplantation, and arterial blood was collected to determine oxygenation index（PaO2/FiO2）. Results The systolic pulmonary artery pressure （Ppa,syst） was monitored by Swan -Gans catheterization one week postransplant, and it was found to have decreased significantly [from （50.00±13.00） mm Hg （1 mm Hg=0. 133 kPa） to （39.5±7.36） mm Hg,P〈0.05]. Simultaneouly, PaO2/FiO2 was improved [from （241.26 ±79.54）mm Hg to （348.23 ±99.31） mm Hg, P〈0. 05]. Conclusion Single lung transplantation is an efficient way to deal with end - stage pulmonary parenchymal disease combined with pulmonary hypertension.