19例肺移植患者凝血功能指标与预后的相关性分析

Analysis on the relationship between coagulation function and prognosis in 19 lung transplant patients

目的:总结分析19例肺移植患者围术期的凝血功能指标与预后的相关性。方法:回顾性分析2016年12月至2020年12月武汉大学人民医院19例肺移植受体的围手术期临床资料。比较生存组与死亡组基本资料及围手术期(术前1 d、术后第1天、术后1周)凝血功能指标。结果:12例双肺肺移植的手术时间为(509±78)min,7例单肺移植的手术时间为(431±131)min,术前肺平均动脉压力为(38±22) mmHg,术后ICU平均停留时间为(4.60±1.84)d,其中围术期体外膜肺氧合(ECMO)辅助9例,平均辅助时间为(3.00±1.56)d,其中5例死亡(死因包括原发性移植物失功、术后感染、手术后大出血),平均住院时间为(30.00±24.56)d。生存组患者与死亡组术前凝血功能指数无明显差异,而生存组整个围术期凝血功能血小板计数(PLT)明显高于死亡组,而死亡组凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)值明显高于生存组。结论:肺移植围手术期管理中,术前评估纠正患者凝血功能,术中谨慎操作,减少术后大出血风险,及时纠正患者凝血功能紊乱等措施对于肺移植患者平稳渡过围术期具有重要意义。

Objective:To summarize and analyze the correlation between perioperative coagulation function and prognosis of 19 lung transplant patients in Renmin Hospital of Wuhan University.Methods:The perioperative clinical information of 19 lung transplant recipients in our hospital from December 2016 to December 2020 was analyzed retrospectively.The basic information and coagulation function indexes in the perioperative period(preoperative day 1, postoperative day 1, and postoperative week) were compared between the survival and death groups.Results:The operative time was(509±78) min for12 double-lung lung transplants and(431±131) min for 7 single-lung transplants, the mean preoperative pulmonary arterial pressure was(38±22) mmHg, and the mean postoperative ICU stay was(4.60±1.84)d, including 9 cases with perioperative ECMO assistance and a mean assistance time of(3.00±1.56)d.Five of them died(the causes of death including PGD, postoperative infection,and postoperative hemorrhage) with a mean hospital stay of(30.00±24.56)d.The perioperative coagulation platelet count(PLT) was significantly higher in survival group than in death group, whereas the prothrombin time(PT), international normalized ratio(INR), and activated partial thromboplastin time(APTT) values were significantly higher in the death group than in the survival group.Conclusion:In the perioperative management of lung transplantation, preoperative assessment to correct patients’ coagulation function, careful intraoperative operation to reduce the risk of postoperative hemorrhage, and timely correction of patients’ coagulation disorders are important for lung transplantation patients to pass through the perioperative period safely.