体外膜肺氧合转流方式对肺移植受者术后生化指标的影响

The effect of extracorporeal membrane oxygenation on postoperative biochemical indicators in lung transplant patients

目的对比分析肺移植受者采用不同的体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)转流方式的术后7 d内的血红蛋白、血小板以及肝肾功能情况。方法回顾性分析2021年4月至2022年12月于南京医科大学附属无锡人民医院就诊并接受肺移植的144例患者临床资料,根据肺移植患者是否接受ECMO以及转流方式不同分为3组:无ECMO组(n=19),V-V ECMO组(n=107)和V-A ECMO组(n=18)。并采用卡方或似然比检验进行比较。结果与无ECMO治疗组相比,V-V ECMO和V-A ECMO组患者术后首次的血红蛋白更低,V-V ECMO组术后第2天的血小板更低,V-A ECMO组2~4 d的血小板水平更低。V-V ECMO和V-A ECMO组术后7 d内的血红蛋白和血小板比较差异并无统计学意义(P>0.05)。与无ECMO组比较,在术后第2天,V-V ECMO组患者肌酐较低,在术后3 d内,V-A ECMO组肌酐较无ECMO组低,在术后4~7 d组间无显著差异。术后3~4 d,V-A ECMO组受者肌酐较V-V ECMO组低。对于肾小球滤过率,无ECMO组与V-V ECMO组患者无显著差异,无ECMO组受者在术后4 d内的肾小球滤过率较V-A ECMO组低,在V-V和V-A两组中,V-V ECMO组在术后7 d内的肾小球滤过率较低,差异有统计学意义(P<0.05)。此外,V-A ECMO组患者术后第3天的胆红素水平比无ECMO组更高。结论本研究发现,ECMO治疗对于患者术后的血小板水平以及肾小球滤过率有一定的影响,且V-A转流方式下患者的术后预后指标要比V-V转流方式佳。

Objective To compare and analyze the hemoglobin,platelet levels and hepatorenal and kidney function of lung transplant recipients who underwent V-V and V-A transfer within 7 d after surgery.Methods The study retrospectively analyzed the recipients who have undergone ECMO after lung transplantation from April 2021 to December 2022 at the Affiliated Wuxi People's Hospital of Nanjing Medical University.The patients were divided into three groups according to whether they received ECMO or not and how they were rerouted:non-ECMO group(n=19),V-V ECMO group(n=107)and V-A ECMO group(n=18).Results Compared with the non-ECMO treatment group,the hemoglobin was lower in V-V ECMO and V-A ECMO groups on the first postoperative day,and the platelet level of the V-V ECMO group was lower on the 2nd day after surgery.V-A ECMO group have a lower platelet level on the 2nd to 4th day.There was no significant difference in hemoglobin and platelet levels between V-V ECMO and V-A ECMO groups within 7 d after surgery(P>0.05).Compared with the non-ECMO group,the creatinine was lower in the V-V ECMO group on the 2nd day after surgery,and was lower in the V-A ECMO group within the 3 d after surgery,with no significant difference between the groups on the 4th to 7th day after surgery.Compared with the V-V ECMO group,V-A ECMO have a lower creatinine level on the 3rd to 4th days.There were no significant differences in glomerular filtration rates between the non-ECMO group and V-V ECMO within 7 d after surgery.Compared with the V-A ECMO group,the glomerular filtration rate in non-ECMO group was lower within 4 d after surgery.The glomerular filtration rate in V-V ECMO group was lower within 7 d after surgery.In addition,The V-A ECMO group have a higher bilirubin level than non-ECMO group.Conclusion This study found that ECMO treatment has certain effects on the platelet level and glomerular filtration rate of patients after surgery,and the postoperative prognostic indicators of patients with V-A bypass are better than those with V-V bypass.