双肺移植治疗终末期原发性肺动脉高压

Bilateral Lung Transplantation in Treatment of Primary Pulmonary Hypertension

双肺移植治疗原发性肺动脉高压１例。男病人，３０岁。多年来有气短等症状，晕厥４次，反复咯血４年，近期大咯血３次。肺动脉压２０．３／７．３（１３．７）ｋＰａ，全肺阻力３５４．９７８ｋＰａ·ｓ／Ｌ，有中至重度三尖瓣关闭不全。１９９８年１月２０日在体外循环（心脏不停跳）支持下手术。术毕肺动脉压基本正常，三尖瓣关闭不全及反流消失。术后给予三联免疫抑制剂。围手术期有明显的血液动力学紊乱，无明确的急性排斥发生，最主要的并发症是左主支气管吻合口、右上叶及中间干支气管狭窄，目前仍间断行球囊扩张治疗。病人已生存８个多月，状态稳定。

Bilateral lung transplantation was performed in a 30 year old man with endstage primary pulmonary hypertension. Preoperative examinations showed that the mean pulmonary artery pressure(PAP)was 102.5mmHg and total lung resistance was 354.98 kPa·s/L(3549.78 dyne·s·cm -5 ).The patient had moderate tricuspid regurgitation.The lung transplantation was carried out under cardiopulmonary bypass with a beating heart.After transplantation,PAP returned to near normal level and no tricuspid regurgitation was found.Postoperative complications included significant hemodynamic dysfunction and stenosis of anastomoses.The patient survives more than 8 months after operation and returns to normal activities.