探究双肺移植手术安全性并分析影响受者短期预后的危险因素。

回顾性分析中日友好医院胸外科2017年4月至2018年6月30例行双肺移植供、受者临床资料。根据术后90 d受者生存情况，将其分为存活组(22例)和死亡组(8例)。采用成组t检验比较两组供肺获取前供者氧合指数、受者年龄和体质指数、供/受者体表面积差、左/右供肺冷缺血时间、手术时间、术中失血量和输液量。采用Wilcoxon符号秩和检验比较两组受者术中输血量和尿量。采用χ²检验比较供者感染情况、受者性别、原发病、术前感染情况及是否使用呼吸机和体外膜肺氧合(EMCO)、双肺移植顺序、术中是否输血和使用EMCO以及术后是否出现吻合口瘘。P<0.05为差异有统计学意义。

30例供者供肺获取前病原学培养阳性19例，其中单一感染14例，混合感染5例。30例双肺移植受者术前病原学培养阳性16例，其中单一感染12例，混合感染4例。30例受者中11例先行左侧单肺移植，19例先行右侧单肺移植。30例受者术后90 d受者死亡比例为26.7%(8/30)，死亡原因包括感染中毒性休克4例及吻合口瘘、大咯血、循环功能衰竭和活动性出血各1例。短期预后危险因素分析提示，死亡组和存活组受者术中输血量分别为900 mL(0～6 450 mL)和25 mL(0～1 450 mL)，差异有统计学意义(z＝－2.524，P<0.05)。

双肺移植围手术期死亡率较低，受者术中输血量可能影响移植术后受者存活率。

To evaluate the safety of bilateral lung transplantation and its relative risk factors at short-term follow-up.

The clinical data of 30 bilateral lung transplantation recipients who got transplantation in China Japan Friendship Hospital from April 2017 to June 2018 were retrospectively analysed. The recipients were divided into 2 groups according to the survival condition at 90 days after transplantation, 22 recipients were grouped into survival group, and the rest were grouped into death group. Indexes including oxygenation index, age and body index of recipient, difference of body surface area between donor and recipient, cold ischemia duration of donor lungs, operation duration, intraoperative blood loss and infusion between the two groups were compared with independent t test. The volume of blood transfusion and urinary amount during transplantation were compared with Wilcoxon rank sum test. Infectious status of donor, and gender, primary disease, preoperative infectious status, utilization of respirator and extracorporeal membrane oxygenation (ECMO) before operation, sequence of transplantation, transfusion and utilization of ECMO during operation, and anastomotic fistula after operation between the 2 groups were compared with chi-square test. P<0.05 means statistically significant.

Among 30 donors, 19 cases showed positive etiology preoperatively, including 14 cases of single infection and 5 cases of mixed infection. 16 recipients showed positive etiology preoperatively, including 12 cases of single infection and 4 cases of mixed infection. Left lung transplant were performed preferentially in 11 cases, whereas right lung transplant were performed preferentially in 19 cases. Eight recipients died [26.7% (8/30)] during their postoperative 90 days, 4 recipients died of toxic shock. The other 4 recipients died of broncho-bronchus anastomosis fistula, massive hemoptysis, circulation function failure and active bleeding, respectively. The result of the risk factors influencing the short-term prognosis of recipients showed that the blood transfusion volume of survival group and death group were 900 mL (0~6 450 mL) and 25 mL (0~1 450 mL) respectively, which had statistical significance (z=-2.524, P<0.05).

Perioperative mortality of bilateral lung transplant was acceptable. The blood transfusion volume during transplantation could influence the survival rate of recipients at short-term follow-up.