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中华移植杂志(电子版) ›› 2019, Vol. 13 ›› Issue (02) : 81 -86. doi: 10.3877/cma.j.issn.1674-3903.2019.02.001

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诊疗规范

中国肺移植受者选择与术前评估技术规范(2019版)
中华医学会器官移植学分会   
  • 收稿日期:2019-01-17 出版日期:2019-05-25

Techical specification for the selection of recipient and preoperative evaluation of lung transplantation in China (2019 edition)

Branch of Organ Transplantation of Chinese Medical Association   

  • Received:2019-01-17 Published:2019-05-25
引用本文:

中华医学会器官移植学分会. 中国肺移植受者选择与术前评估技术规范(2019版)[J/OL]. 中华移植杂志(电子版), 2019, 13(02): 81-86.

Branch of Organ Transplantation of Chinese Medical Association. Techical specification for the selection of recipient and preoperative evaluation of lung transplantation in China (2019 edition)[J/OL]. Chinese Journal of Transplantation(Electronic Edition), 2019, 13(02): 81-86.

受者筛选是肺移植成功的重要决定因素之一,严格的术前评估及充分准备是获得满意疗效的关键。为了进一步规范我国肺移植受者选择以及术前评估和准备,中华医学会器官移植学分会根据我国近20年肺移植临床实践经验,并结合国际心肺移植协会肺移植受者选择指南,从肺移植适应证和禁忌证、各种终末期肺疾病手术时间选择以及术前检查内容等方面,制订中国肺移植受者选择与术前评估技术规范(2019版)。

表1 肺移植禁忌证
绝对禁忌证
? (1)难以纠正的心脏、肝脏和肾脏等重要器官功能不全(器官联合移植除外)
? (2)恶性肿瘤晚期
? (3)无法通过CABG和PCI缓解的冠心病或合并严重的左心功能不全(但部分患者经严格筛选后可考虑心肺联合移植)
? (4)生理状态不稳定,如败血症、急性心肌梗死和急性肝衰竭等
? (5)无法纠正的出血倾向
? (6)依从性差,不能配合治疗或定期随访
? (7)未治疗的精神疾病或心理状况无法配合治疗者
? (8)缺乏可靠的社会、家庭支持
相对禁忌证
? (1)年龄>75岁(但年龄仅为一项参考条件,无绝对上限)
? (2)进行性或严重营养不良
? (3)严重骨质疏松
? (4)移植前使用机械通气和/或体外生命支持(需谨慎对待,排除其他重要器官的急、慢性功能不全后可考虑行肺移植)
? (5)存在高毒力或高度耐药的细菌、真菌定植或感染,或特定的分枝杆菌菌株定植或感染(如慢性肺部感染且预期肺移植术后难以控制)
? (6)HBV或HCV感染(排除肝硬化和门静脉高压且无明显临床症状、影像学和生化检查无异常者可行肺移植)
? (7)HIV感染(HIV-RNA检测阴性并联合抗逆转录病毒治疗者,可考虑在HIV治疗经验丰富的移植中心行肺移植)
? (8)洋葱伯克霍尔德菌、唐菖蒲伯克霍尔德菌和多重耐药的分枝杆菌感染(得到充分治疗和控制者可在感染治疗经验丰富的移植中心行肺移植)
? (9)动脉粥样硬化性疾病(可在肺移植前予相应治疗,如冠心病患者应在肺移植术前行PCI或CABG)
? (10)其他未达到终末期状态的疾病(如糖尿病、高血压、消化性溃疡或胃食管反流等,应在肺移植术前积极处理)
表2 COPD肺移植评估和移植标准
表3 ILD肺移植评估和移植标准
表4 CF/支气管扩张肺移植评估和移植标准
表5 PAH肺移植评估和移植标准
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