体外膜肺氧合辅助肺移植术治疗对终末期肺病患者预后的影响及相关因素分析

The influence of ECMO supplemented with lung transplantation on prognosis of patients with end-stage lung diseases and analysis of its related factors

目的探讨体外膜肺氧合(ECMO)辅助肺移植术治疗对终末期肺病患者预后的影响及相关因素。方法回顾性分析2020年4月至2022年6月我院开展的87例ECMO辅助肺移植术治疗的终末期肺病患者,其中44例行静脉-动脉(V-A)转流为VA-ECMO组,43例行静脉-静脉(V-V)转流为VV-ECMO组,比较两组患者临床资料、手术相关指标、术后并发症及预后,分析影响终末期肺病患者预后的危险因素。结果VA-ECMO组平均肺动脉压及重度动脉压占比显著高于VV-ECMO组(P<0.05);手术时间显著高于VV-ECMO组,ECMO流转时间显著低于VV-ECMO组(P<0.05);两组术后PGD率、术后72 h内休克率、再次气管插管或气管切开率、术后6个月生存率比较,差异无统计学意义(P>0.05);多因素Logistic回归分析显示,肺动脉压、ECMO转流时间、术后PGD、再次气管插管或气管切开是影响终末期肺病患者预后的危险因素(P<0.05)。结论ECMO辅助肺移植术治疗终末期肺病采用V-A转流和V-V转流患者短期预后比较无显著性差异,而肺动脉压、ECMO转流时间、术后PGD、再次气管插管或气管切开是影响终末期肺病患者预后的危险因素。

Objective To explore the influence of extracorporeal membrane oxygenation(ECMO)supplemented with lung transplantation on the prognosis of patients with end-stage lung diseases and to analyze its related factors.Methods The data of 87 patients with end-stage lung diseases underwent ECMO-assisted lung transplantation in our hospital from April 2020 to June 2022 were retrospectively analyzed.Among the patients,44 treated with veno-arterial(V-A)bypass were enrolled in a VA-ECMO group,and 43 treated with veno-venous(V-V)bypass were included in a VV-ECMO group.Clinical data,surgery-related indicators and postoperative complications were compared between the two groups.The risk factors affecting the prognosis of the patients were analyzed.Results The average pulmonary artery pressure and the proportion of severe arterial pressure in the VA-ECMO group were significantly higher than those in the VV-ECMO group(P<0.05).The surgical time in the VA-ECMO group was significantly longer than that in the VV-ECMO group(P<0.05).The ECMO flow time in the VA-ECMO group was significantly lower than that in the VVECMO group(P<0.05).There were no statistically significant differences in primary graft dysfunction(PGD)rate after surgery,shock rate within 72h after surgery,retracheal intubation or tracheotomy rate,and 6-month postoperative survival rate between the two groups(P>0.05).Multivariate logistic regression analysis showed that pulmonary artery pressure,ECMO bypass time,postoperative PGD and retracheal intubation or tracheotomy were risk factors affecting the prognosis of these patients(P<0.05).Conclusions There is no significant difference in short-term prognosis between patients with VA bypass and with VV bypass in ECMO-assisted lung transplantation for end-stage lung diseases.The risk factors afecting the prognosis of the patients are pulmonary artery pressure,ECMO bypass time,postoperative PGD and retracheal intubation or tracheotomy.