肺移植围手术期体外膜肺氧合的应用研究

Extracorporeal membrane oxygenation for lung transplantation of perioperative application

目的探讨将体外膜肺氧合(ECMO)应用于肺移植围手术期的应用效果。方法选取2017年1月—2022年12月郑州大学第一附属医院收治的63例行肺移植的受者,回顾性分析患者临床资料,将63例患者依据ECMO置管方式分为静脉-静脉(venous-venous,V-V)组(23例)与静脉-动脉(venous-artery,V-A)组(40例),依据术后ECMO支持时间分为延长组(术后ECMO支持时间>72 h,7例)与未延长组(术后ECMO支持时间≤72 h,37例),对比V-A组与V-V组基础资料及术后临床转归情况,并比较延长组与未延长组预后情况。结果V-A组与V-V组性别、年龄、肺移植方式、围术期ECMO支持时间、撤除情况及原发病比较,差异无统计学意义(P>0.05);V-A组与V-V组手术时间、再次插管率、探查止血率、ICU停留时间及住院时间比较,差异无统计学意义(P>0.05);V-A气管拔管时间长于V-V组,差异有统计学意义(P<0.05);延长组患者术后30 d、60 d、90 d累积生存率分别为85.71%、71.43%、57.14%,未延长组分别为91.89%、86.49%、78.38%,高于延长组,差异有统计学意义(P<0.05)。结论肺移植受者围手术期应用ECMO具有重要作用,可提高患者生存率,V-V置管方式创伤小,相较于V-A置管可缩短气管拔管时间;术后ECMO支持时间延长相较于不延长患者预后更差。

Objective To investigate the effect of extracorporeal membrane oxygenation(ECMO)in the perioperative period of lung transplantation.Methods A retrospective analysis was performed on 63 patients who received lung transplantation in the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2022.According to different ECMO catheterization methods,the patients were divided into two groups,including 23 cases in group V-V and 40 cases in group V-A.According to the postoperative ECMO support time,the patients were divided into extended group(ECMO support time>72 h,7 cases)and non-extended group(ECMO support time≤72h,37 cases).The basic data and postoperative clinical outcomes of the V-A group and the V-V group were compared,and the prognosis of the prolonged group and the non-prolonged group was compared.Results There was no significant difference between V-A group and V-V group in gender,age,lung transplantation mode,perioperative ECMO support time,removal situation and primary disease(P>0.05).There was no significant difference in operation time,reintubation rate,exploration hemostasis rate,ICU stay time and hospital stay between the V-A group and the V-V group(P>0.05).The duration of tracheal extubation in V-A group was longer than that in V-V group(P<0.05).The cumulative survival rates at 30 d,60 d and 90 d in the extended group were 85.71%,71.43%and 57.14%,respectively,while those in the non-extended group were 91.89%,86.49%and 78.38%,respectively,which were higher than those in the extended group(P<0.05).Conclusion The use of ECMO in the perioperative period of lung transplant recipients has an important role in improving the survival rate of patients.V-V catheterization has less trauma and can shorten the time of tracheal extubation compared with V-A catheterization.Patients with prolonged ECMO support had worse prognosis than those without prolonged ECMO support.