19例肺移植受者围术期血流动力学管理总结

Summary of perioperative hemodynamic management of 19 lung transplant recipients

目的:总结肺移植受者围术期血流动力学管理方面的治疗经验。方法:2016年12月至2020年12月武汉大学人民医院共行19例肺移植手术,术后均转回重症医学科监护治疗,回顾性分析其临床资料。结果:主要诊断为慢性阻塞性肺疾病(COPD)5例、特发性肺纤维化(IPF)5例,尘肺4例,支气管扩张2例,COVID-19晚期肺纤维化1例,结缔组织病相关性肺纤维化1例,Kartagener综合征1例。手术方式:双肺移植12例,单侧肺7例(左单肺移植4例,右单肺移植3例)。围术期死亡6例,死因分别为:肺部多重耐药菌感染1例,术后胸腔活动性出血导致的循环功能衰竭1例,术中心跳骤停1例,3例因术后多器官功能衰竭家属放弃出院。余13例均顺利出院。19例受体中,14例使用了升压药物。受者术后3 d总液体及每日液体出量大于入量(P<0.05)。结论:肺移植是治疗终末期肺病的有效方法,围术期对血流动力学进行精细化管理,在满足全身灌注的前提下维持尽可能低的血容量,限制液体入量,尽量以白蛋白或血浆为主提高胶体渗透压,加强右心功能维护,有可能改善肺移植受者的预后。

Objective:To summarize and discuss the experience of perioperative hemodynamic management of lung transplant recipients.Methods:A total of 19 lung transplant recipients from December 2016 to December 2020 were investigated in Renmin Hospital of Wuhan University, all of which were transferred to the intensive care unit for further monitoring and treatment, and their clinical data were retrospectively analyzed.Results:The 19 lung transplant recipients included 5 cases of chronic obstructive pulmonary disease(COPD), 5 cases of idiopathic pulmonary fibrosis(IPF), 4 cases of pneumoconiosis, 2 cases of bronchiectasis, 1 case of later lung fibrosis associated with COVID-19, 1 case of connective tissue disease-related pulmonary fibrosis, and 1 case of Kartagener syndrome.Twelve cases adopted double lung transplantation, while seven cases reveived unilateral lung transplantation(4 cases of left single lung transplantation and 3 cases of right single lung transplantation).There were 6 deaths during the perioperative period.One case died of multi-drug resistant bacteria infection, one case died of circulatory failure caused by active thoracic hemorrhage post-operation, the third case died of intraoperative cardiac arrest, and the other 3 cases were given up because of multiple organs failure.The remaining 13 cases were cured and discharged.Of the 19 recipients, 14 received vasopressors.The total and daily fluid output of the recipients in 3 postoperation days were greater than the input volume(P<0.05).Conclusion:Lung transplantation is an effective method for the treatment of end-stage lung disease.The hemodynamic management is a keypoint during perioperative period.It is import to maintain the blood volume as low as possible under the premise of systemic perfusion, limit the amount of fluid, choose albumin or plasma to increase the colloidal osmotic pressure, and strengthen the maintenance of right heart function.These abobe measures may improve the prognosis of lung transplant recipients.