术前肺动脉高压对肺纤维化患者肺移植术后早期存活率的影响

Effect of preoperative pulmonary artery pressure on early survival after lung transplantation for idiopathic pulmonary fibrosis

目的探讨术前肺动脉高压对特发性肺纤维化（IPE）患者肺移植术后早期（〈90d）存活率的影响。方法2002年9月至2009年4月为30例特发性肺纤维化患者进行了肺移植。根据术前肺动脉压的检测结果，将30例患者分为两组。肺动脉高压组：13例，术前平均肺动脉压≥30mmHg；对照组：17冽，术前平均肺动脉压〈30mmHg。对两组患者的年龄、术式（单、双肺移植）、肺动脉压力、是否应用体外膜氧合（ECMO）等进行多因素逻辑回归分析比较。结果肺动脉高压组和对照组患者肺移植术后早期存活率分别为61．5％和94．1％，两组比较，差异有统计学意义（P〈0．05）。统计学分析显示．术前肺动脉高压是影响患者肺移植术后早期存活率的独立危险因素，而年龄、术式及是否使用ECMO等并非是影响肺移植术后早期存活率的独立危险因素。结论术前肺动脉高压是影响患者肺移植术后早期存活率的独立危险因素；特发性肺纤维化患者肺移植前应重点评估其肺动脉压力；

Objective To estimate the effects of preoperative pulmonary hypertension on early survival （91） days） after lung transplantation for idiopathic pulmonary fibrosis （IPF）. Methods We reviewed 30 cases of lung transplant patients which suffered from IPF. According to the pulmonary artery pressure,non-pulmonary hypertension group （n = 17） and pulmonary hypertension group （n = 13） were set up. Risk factors were assessed individually and adjusted for confounding by a multivariabte logistic regression model. The early outcomes （90 days） were compared in two groups by the Х^2 test. Results The early survival rate was 61.5% and 94. 1 % in pulmonary hypertension group and non-pulmonary hypertension group respectively （P〈0.05）. Multivariate analysis confirmed that mean pulmonary artery pressure was independent risk factors after adjustment for potential confounders. Recipient age, operating procedure, and use of extracorporeal membrane oxygenation （ECMO） were not independent risk factors for early mortality. Conclusion The increased pulmonary artery pressure is an independent risk factor for death after single-lung transplantation in IPF. Mean pulmonary artery pressure should be included in the overall risk assessment of patients with IPF evaluated for lung transplantation.