单中心肺移植麻醉管理总结

A single center experience of anesthetic management for lung transplantation

目的:总结肺移植围术期麻醉管理经验,探讨围术期麻醉管理对肺移植结局的影响。方法:回顾性分析2016年12月—2020年12月武汉大学人民医院19例肺移植患者临床资料。结果:19例肺移植患者ASA分级Ⅳ~Ⅴ级,心脏彩超检查提示肺动脉收缩压>70 mmHg 6例,50~70 mmHg 5例,30~50 mmHg 5例。双肺移植12例,左单肺移植4例,右单肺移植3例。其中9例患者在体外膜肺氧合(ECMO)辅助下完成肺移植手术(2例为术前已经使用ECMO桥接治疗,术中继续ECMO辅助维持)。围术期死亡6例,死因分别为:多器官功能衰竭3例;肺移植术后移植物失功、呼吸衰竭1例;术中心跳骤停1例;术后急性心肌梗死,患者家属放弃治疗要求出院1例;余13例均顺利出院。结论:肺移植是治疗终末期肺病的有效方法,心肺联合功能差的老年患者,围术期死亡风险明显增大,术前积极调整重要脏器功能,重视基础疾病的治疗,术中精细管理,正确及时使用ECMO辅助,可能改善肺移植患者的预后,降低围术期死亡率。

Objective:To summarize anesthetic management experience during lung transplantation, and to explore the influence of anesthetic management on the outcome of lung transplantation.Methods:The clinical data of 19 patients received lung transplantation in Renmin Hospital of Wuhan University from December 2016 to December 2020 were retrospectively analyzed.Results:A total of 19 patients with American Society of Anesthesiologists(ASA)physical status Ⅳ-Ⅴ underwent lung transplantation, and color Doppler echocardiography showed pulmonary artery systolic pressure >70 mmHg in 6 cases, 50-70 mmHg in 5 cases and 30-50 mmHg in 5 cases.There were 12 cases of double lung transplantation, 4 cases of left single lung transplantation and 3 cases of right single lung transplantation.9 cases were under extracorporeal membrane oxygenation(ECMO) assist for surgery.Among them, 2 cases were under ECMO assist in intensive care unit(ICU) before surgery.There were 6 deaths during the perioperative period:3 cases died of multiple organ disfunction disease, 1 dead of graft failure,and 1 died of cardiac arrest during surgery, 1 case was discharged due to a postoperative myocardial infarction and the remaining 13 cases were cured and discharged.Conclusion:Lung transplantation is an effective method for the treatment of end-stage lung disease.Elderly patients with poor cardiopulmonary function have a significantly increased perioperative mortality.Stratrgies such as suitable adjustments before surgery, attention to the underlying diseases, precise intraoperative management,and properly and timely ECMO assistance, may improve the outcome of lung transplantation and reduce perioperative mortality.