棉子糖低钾右旋糖酐液在临床肺移植中的应用

Raffinose-iow potassium dextran solution in clinical lung transplantation： a retrospective study

目的探讨棉子糖低钾右旋糖酐（RLPD）液保存供肺的效果。方法自2002年9月至2011年12月共完成肺移植131例，其中单肺移植81例，双肺移植50例。供者129例，其中2例供者的左、右肺分别移植给4例受者。供肺获取时先用RLPD液顺行灌注4L，再逆行灌注1L，随后将供肺保存于3L低温RLPD液中。根据供肺冷缺血时间长短及供肺质量决定是否行二次灌注。手术期间严密监测受者动脉血液气体、平均肺动脉压（mPAP）、呼吸力学指标的变化，术后定期复查心脏超声、肺功能、血液气体和胸部影像学等检查。结果肺移植手术均顺利完成，供肺冷缺血时间为（193±21）min（65-630）min。术后早期肺水肿与供肺冷缺血时间、原发性移植物无功能（PGD）的发生有关（P〈0．05，P〈0．01）。供肺开放双肺通气及术后2h所有受者动脉血液气体、氧合指数均明显改善，mPAP、气道阻力和双肺通气气道内吸气峰压明显下降。术后早期（1个月内）死亡率为18．3％（24／131），死亡原因包括严重感染11例，原发性移植物无功能7例，心功能衰竭3例，支气管吻合口漏1例，急性排斥反应1例，肺梗死1例。肺移植术后3个月，用力肺活量、第1秒用力呼气容积，每分钟最大通气量、一氧化碳弥散量较术前明显改善。结论RLPD液能有效减轻肺缺血再灌注损伤、改善肺功能，提高供肺保存效果。

Objective To evaluate the security and effectiveness of raffinose-low potassium dextran solution （RLPDs） for donor lung preservation. Methods From Sep. 2002 to Dec. 2011, 131 patients underwent lung transplantation in our institution, including 81 cases of single lung transplantation and 50 cases of bilateral lung transplantation. There were 95 males and 36 females. A total of 129 donors were used for organ harvest. Two donors denoted their lungs to four patients receiving single lung transplantation. All the donors were flushed, perfused antegradely and retrogradely, and preserved with hypothermal RLPDs. The repeated repeffusion was necessary when the cold ischemic time was fairly long and the function of donor was poor. During operation, the blood gas analysis, mean pulmonary artery pressure （mPAP） and breathing mechanics were monitored. Postoperatively, all the recipients received re-examination of cardiac ultrasonography, pulmonary function, blood gas analysis and chest imaging. Results All lung transplantations were performed successfully, with a mean cold ischemic time of （193 ± 21） rain （range, 65 - 630 min）. There was a significant relationship between postoperative pneumonedema and donor lung cold ischemic time （P〈 0. 05）, which was also observed between postoperative pneumonedema and primary graft dysfunction （P 〈 0.01 ）. The blood gas analysis and oxygenation index were significantly improved postoperatively, with the mPAP and parameters of breathing mechanics being descended to a normal level. There were 24 early deaths in the first month post-transplant, with a mortality of 18. 3% （24/ 131）, including 11 cases of sepsis, 7 cases of primary graft dysfunction, 3 cases of heart failure, 1 case of bronchial stomal leak, 1 case of acute rejection, and 1 case of pulmonary infarction. The pulmonary function was improved significantly 3 months postoperatively. Conclusion RLPDs is efficient in the preservation of donor lung, with the ability to alleviate ischemic reperfusion injury and improve pulmonary function.