肺移植术后中心气道狭窄危险因素分析

Risk factors analysis of central airway stenosis after lung transplantation

目的探讨肺移植术后发生中心气道狭窄的危险因素。方法回顾性分析2016年7月至2017年12月在南京医科大学附属无锡人民医院接受肺移植的155例受者的临床资料。根据术后中心气道狭窄的发生情况,将受者分为狭窄组(36例)和对照组(119例),总结肺移植术后中心气道狭窄的发生情况;采用单因素和多因素logistic回归分析肺移植术后中心气道狭窄的危险因素。结果155例肺移植受者中,36例发生中心气道狭窄,发生率为23.2%,平均发生时间为术后(53±13)d。单因素分析结果显示,双肺移植、原发性移植物功能障碍(PGD)3级、气道真菌感染、冷缺血时间长、机械通气时间长、重症监护室(ICU)入住时间长是肺移植术后发生中心气道狭窄的危险因素(均为P<0.05)。多因素分析结果显示,气道真菌感染、冷缺血时间长、机械通气时间长是肺移植术后发生中心气道狭窄的独立危险因素(均为P<0.05)。结论肺移植术后气道存在真菌感染及冷缺血时间、机械通气时间较长可能会导致肺移植术后中心气道狭窄。应采取积极措施预防,密切监测,以改善肺移植术后受者生存质量。

Objective To investigate the risk factors of central airway stenosis after lung transplantation.Methods Clinical data of 155 recipients undergoing lung transplantation in Wuxi People's Hospital Affiliated to Nanjing Medical University from July 2016 to December 2017 were retrospectively analyzed.According to the incidence of central airway stenosis following lung transplantation,all recipients were divided into the stenosis group(n=36)and control group(n=119).The incidence of central airway stenosis after lung transplantation was summarized.The risk factors of central airway stenosis after lung transplantation were assessed by univariate and multivariate logistic regression analyses.Results Among 155 lung transplant recipients,36 cases(23.2%)developed central airway stenosis.The average incidence time was(53±13)d after lung transplantation.Univariate analysis demonstrated that bilateral lung transplantation,grade 3 primary graft dysfunction(PGD),airway fungal infection,long cold ischemia time,long mechanical ventilation time and long intensive care unit(ICU)stay were the risk factors for central airway stenosis after lung transplantation(all P<0.05).Multivariate analysis showed that airway fungal infection,long cold ischemia time and long mechanical ventilation time were the independent risk factors for central airway stenosis after lung transplantation(all P<0.05).Conclusions Airway fungal infection after lung transplantation,long cold ischemia time and long mechanical ventilation time probably lead to central airway stenosis after lung transplantation.Active preventive measures and intimate monitoring should be taken to improve the quality of life of the recipients after lung transplantation.