肺移植患者重症医学科管理经验总结

Experience of management to patients with lung transplantation in intensive care unit

目的总结肺移植术后重症医学科管理经验。方法四川省人民医院2015年共完成2例肺移植手术,病例1为矽肺患者,病例2为肺间质纤维化患者,术前合并严重呼吸衰竭,大剂量应用糖皮质激素,以ECMO辅助;2例患者均行同种异体原位双肺移植术,术后给予控制肺水、免疫抑制、感染防控、早期康复等治疗。探讨重症医学科对肺移植患者的管理经验。结果病例1恢复良好,术后第3天可随意下床活动,术后21 d顺利出院,至今生活良好。病例2因先后并发支气管吻合口瘘、重症肺炎、肝功能衰竭,给予积极抗感染、保肝降黄、营养支持及康复治疗,但治疗效果不佳,于术后73 d死亡。结论良好的重症医学科管理是肺移植术后患者康复的重要保障。术前使用大剂量激素的患者,术后吻合口瘘的发生风险更高。ECMO是危重患者安全度过围术期的有力保障,一旦患者呼吸、循环稳定,宜尽早撤除。

Objective To summarize the experience of management to patients with lung transplantation in intensive care uniL Methods Two cases of lung transplantation were carried out in Sichuan Provincial People＇s Hospital in 2015. Case 1 was a silicosis patient. Case 2 had pulmonary fibrosis with severe respiratory failure. We applied large doses of glucocorticoid and ECMO for this patient before surgery. The surgical approaehe was sequential bilateral single-lung transplantation. Measures for lung water control, immunosuppression, and anti-infection, rehabilitation were carried out after transplantation. The experience of management to patients with lung transplantation in intensive care unit was explored. Results Case 1 recovered well. The patient could be free to get out of bed at the 3rd day after surgery and discharged at the 21st day. Case 2 died at the 73rd day after surgery because of bronchial anastomotic fistula, severe pneumonia and liver failure, although the patient was recieved positive anti-infection, liver protection, nutritional support and rehabilitation, but the treatment was ineffective. Conclusion Good management in intensive care unit is the important guarantee of the recovery with lung transplantation. The patient who use of large doses of glucocorticoid before surgery with higher riskof bronchial anastomotic fistula after surgery. ECMO is an important supportion for critical patient in perioperation. Once the breathing and circulation of the patient stably, we should remove ECMO as soon as possible.