继发性肺动脉高压对肺移植受者预后的影响

Effects of secondary pulmonary hypertension on lung transplant outcomes

目的观察分析继发性肺动脉高压(SPH)对肺移植受者预后的影响。方法回顾性分析南京医科大学附属无锡人民医院2015年1月至2017年12月收治的309例肺移植受者的住院资料。根据术前肺动脉平均压(mPAP)分为正常组(mPAP<25 mmHg,56例)、低压组(25 mmHg≤mPAP<40 mmHg,155例)和高压组(mPAP≥40 mmHg,98例),比较三组受者术前资料、术中情况、术后转归及存活情况。绘制术后生存的Kaplan-Meier曲线,进行Log-Rank检验。对253例SPH受者进行多因素Cox回归分析影响术后存活的因素。结果三组受者终末慢性肺病(CLD)分布差异有统计学意义(χ^2=30.837,P=0.001)。mPAP等级不同受者术中体外膜氧合(ECMO)支持的决策不同(χ^2=28.205,P<0.001)。正常组、低压组和高压组2年存活率分别为58.9%、63.9%和69.4%,差异无统计学意义(P=0.513)。多因素Cox回归分析发现,术前心功能分级是影响SPH受者存活的独立危险因素。心功能Ⅲ/Ⅳ级的受者术后死亡风险是Ⅰ/Ⅱ级的1.796倍(95%CI:1.078~2.991,P=0.025)。结论SPH受者术前应重视心功能分级评估,在心功能失代偿早期选择手术可能获得更好的生存预期。

Objective To explore the effects of secondary pulmonary hypertension(SPH)on postoperative outcomes of lung transplant recipients.Methods The hospitalization data of 309 patients undergoing lung transplant were retrospectively analyzed.They were divided into normal(mPAP<25 mmHg,56 cases),low-pressure(mPAP:25 mmHg≤mPAP<40 mmHg,155 cases)and high pressure(mPAP≥40 mmHg,98 cases)groups.Three groups were compared with regards to general profiles,intraoperative status,postoperative outcomes and survival rates.The postoperative patient survival was plotted by Kaplan-Meier curve and log-rank test performed.Multivariate Cox regression analysis was performed to explore the influencing factors of postoperative survival.Results The distribution of chronic lung disease(CLD)was statistically different among 3 groups(χ^2=30.837,P=0.001).Patients with different levels of pulmonary artery pressure had different decisions supported intraoperatively by extracorporeal membrane oxygenation(ECMO)(χ^2=28.205,P<0.001).The 2-year survival rates of normal,low-pressure and high-pressure groups were 58.9%,63.9%and 69.4%respectively and there were no statistically significant differences(P=0.513).Multivariate Cox regression analysis indicated that preoperative cardiac function was an independent risk factor for postoperative survival.The postoperative risk of mortality was 1.796(95%CI:1.078~2.991)folds higher in patients with cardiac function gradeⅢ/Ⅳthan those with gradeⅠ/Ⅱ(P=0.025).Conclusions Preoperative classification of cardiac function should be emphasized in SPH patients.And surgery during early decompensated stage of cardiac function may confer a better survival.