肺移植治疗新型冠状病毒感染后肺纤维化三例临床经验

Practical experiences of managing COVID-19 in lung transplantation

目的:探讨肺移植治疗2019新型冠状病毒(2019-nCoV)感染后肺间质纤维化的手术指征、医务人员防护措施。方法:2020年2月15日至2020年3月1日分别为3例2019-nCoV感染后肺间质纤维化患者实施肺移植手术,分析3例受者的发病时间、机械通气时间、体外膜肺氧合(ECMO)支持时间、手术过程,以及术中医务人员的防护措施。结果:3例受者发病时间分别为40、37、39 d,机械通气时间分别为26、22、27 d,ECMO支持时间分别为16、7、14 d。3例切除患肺的术后病理结果均提示肺间质纤维化。1例受者手术当日死亡,2例受者存活,目前在康复治疗中。39位医务人员术后隔离14 d后无2019-nCoV感染症状,经过2次鼻拭子、咽拭子2019-nCoV核酸检测均为阴性。结论:2019-nCoV感染后肺间质纤维化患者经积极内科治疗1个月后,病情无好转,1个月以内的死亡风险大于50%,2019-nCoV核酸检测转阴,可考虑行肺移植术。术中对医务人员行三级防护可避免医务人员感染2019-nCoV。

Objective To explore the indications of lung transplantation for pulmonary interstitial fibrosis after COVID-19 and the precautionary measures of medical staff during operation.Methods Lung transplantation was performed for three cases of COVID-19 from February 15,2020 to March 1,2020.The course of disease,mechanical ventilation time,extra-corporeal membrane oxygenation(ECMO)support time,surgical procedures and precautionary measures of medical staff during operation were analyzed.Results The course of disease were 40,7,39 days,the mechanical ventilation time 26,22,27 days and ECMO support time 16,7,14 days.The postoperative pathological results of three cases indicated pulmonary interstitial fibrosis.One case died on the operative day and two survivors stayed currently in rehabilitation.Thirty-nine medical staff had no symptoms of COVID-19 after 14 days of isolation.The detection of 2019-nCoV nucleic acid was negative for both nasal and pharyngeal swabs.Conclusions Patients with pulmonary interstitial fibrosis after COVID-19 show no improvement after 1 month of active medical treatment.And the 1-month risk of mortality was over 50%and nucleic acid of 2019-nCoV turned negative.Lung transplantation might be considered.The triple precautionary levels of medical staff during operation prevented the transmission of 2019-nCoV.