摘要
目的评估静脉-动脉(V-A)和静脉-静脉(V-V)转流方式的体外膜氧合(ECMO)辅助下的肺移植受者临床特征及预后情况。方法回顾性分析2016年至2018年南京医科大学附属无锡人民医院开展的ECMO辅助下肺移植手术220例(V-A转流147例,V-V转流73例)的临床资料。比较两组受者临床资料、术后并发症及短期生存状况的差异。结果V-A组供者性别为女性的比例、手术时间、输血量和尿量均高于V-V组(P<0.05),但ECMO转流时间低于V-V组(P<0.001)。两组之间术后再开胸、肺部感染、原发性移植物功能丧失及肾功能不全等并发症的发生率以及输血量和机械通气时间的差异均无统计学意义(P>0.05),短期存活率差异也无统计学意义(P>0.05)。ECMO转流时间与术后机械通气时间和短期存活率独立相关,转流时间12.0~23.9 h、24.0~47.9 h和≥48 h的受者术后机械通气时间≥3 d的风险分别是转流时间<12 h者的7.48(95%CI:2.61~21.49)、12.30(95%CI:4.54~33.33)和16.02(95%CI:5.25~48.84)倍,术后短期死亡的风险分别是转流时间<12 h者的2.21(95%CI:1.00~4.86)、2.73(95%CI:1.34~5.56)和6.63(95%CI:3.23~13.59)倍。结论V-A和V-V转流方式对肺移植受者术后并发症和短期存活率无影响,但转流时间对受者短期生存状况具有预测价值。
Objective To evaluate the clinical characteristics and prognoses of recipients of lung transplantation(LTx)under venous-arterial(V-A)versus veno-venous(V-V)bypass of extracorporeal membrane oxygenation(ECMO).Methods A total of 220 patients undergoing LTx supported by ECMO were recruited.Based upon the types of ECMO,they were divided into two groups of V-A(147 cases)and V-V(73 cases).Perioperative data of donor/recipient,including postoperative complications and short-term survival rates,were retrospectively analyzed.Results The proportions of female donors,operative duration,volume of blood transfusion and urine production were higher in V-A group than those in V-V group(P<0.05).And ECMO bypass time was lower in V-A group than that in V-V group(P<0.001).The postoperative complications of thoracotomy,pulmonary infection,primary graft dysfunction,renal dysfunction,volume of blood transfusion,mechanical ventilation time and short-term survival rate differed insignificantly between two groups(P>0.05).The extension of ECMO bypass time was correlated with postoperative mechanical ventilation time and short-term survival rate.Compared to patients with a ECMO bypass time<12 h,the risk of mechanical ventilation≥3 days was 7.48(95%CI:2.61~21.49),12.30(95%CI:4.54~33.33)and 16.02(95%CI:5.25~48.84)folds.And the risk of early postoperative death was 2.21(95%CI:1.00~4.86),2.73(95%CI:1.34~5.56)and 6.63(95%CI:3.23~13.59)folds greater for patients with a bypass time of 12.0~23.9,24.0~47.9 and≥48 h respectively.Conclusions Under the current regimen of ECMO application,bypass type of ECMO does not affect the postoperative complications and short-term survival rates.Yet ECMO bypass time has a predictive value for short-term survival time of recipients.
作者
李小杉
陈静瑜
于慧智
卫栋
胡春晓
Li Xiaoshan;Chen Jingyu;Yu Huizhi;Wei Dong;Hu Chunxiao(Lung transplantation center,Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi 214023,China;Department of Anesthesiology,Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi 214023,China)
出处
《中华器官移植杂志》
CAS
北大核心
2020年第12期740-744,共5页
Chinese Journal of Organ Transplantation
关键词
肺移植
体外膜氧合
存活率
Lung transplantation
Extracorporeal membrane oxygenation
Survival rate
