肺移植术后原发性移植物功能障碍诊治指南

doi:10.3877/cma.j.issn.1674-3903.2026.01.002

原发性移植物功能障碍(PGD)是肺移植术后最常见且最具挑战性的早期并发症，严重影响患者的近期及远期预后。为规范和优化肺移植术后PGD诊治的流程，改善此类受者预后，中华医学会器官移植学分会肺移植学组和国家卫生健康委肺移植质控中心组织成立了由肺移植科、重症医学科、呼吸与危重症科、心胸外科、康复科等多学科专家组成的工作组，结合近年来循证医学依据和我国肺移植临床实践经验，制定《肺移植术后原发性移植物功能障碍诊治指南》。本指南涵盖PGD的高危因素、诊断、治疗、预后等内容，并科学规范地提出系列推荐意见，旨在优化我国肺移植术后PGD的综合管理。

关键词: 肺移植, 原发性移植物功能障碍, 临床指南, 管理异质性, 预后

Primary graft dysfunction (PGD) is the most common and challenging early complication after lung transplantation, with a profound impact on both short- and long-term outcomes. To standardize and optimize the diagnosis and management of PGD and improve the prognosis of lung transplant recipients, the Lung Transplantation Group, Chinese Society of Organ Transplantation, Chinese Medical Association and China Quality Management and Control Center for Lung Transplantation convened a multidisciplinary working group. This group comprised experts from lung transplantation, intensive care medicine, respiratory and critical care medicine, cardiothoracic surgery and rehabilitation medicine. Drawing on recent evidence-based findings and the clinical practice experience of lung transplantation in China, the group developed the Guidelines for the Diagnosis and Management of Primary Graft Dysfunction After Lung Transplantation. The guideline addresses risk factors, diagnostic criteria, therapeutic strategies and prognosis of PGD, and provides a series of scientifically sound and standardized recommendations aimed at optimizing the comprehensive management of PGD in China.

Key words: Lung transplantation, Primary graft dysfunction, Clinical guidelines, Management heterogeneity, Prognosis

表1 2009年牛津大学证据分级与推荐意见强度分级标准

推荐强度	证据级别	描述
A	1a	RCTs的系统评价
	1b	结果可信区间小的RCT
	1c	显示"全或无效应"的任何证据
B	2a	队列研究的系统评价
	2b	单个的队列研究(包括低质量的RCT，如失访率>20%)
	2c	基于患者结局的研究
	3a	病例对照研究的系统评价
	3b	单个病例对照研究
C	4	病例系列报告、低质量队列研究和低质量病例对照研究
D	5	专家意见(即无临床研究支持的仅依据基础研究或临床经验的推测)

表1 2009年牛津大学证据分级与推荐意见强度分级标准

推荐强度	证据级别	描述
A	1a	RCTs的系统评价
	1b	结果可信区间小的RCT
	1c	显示"全或无效应"的任何证据
B	2a	队列研究的系统评价
	2b	单个的队列研究(包括低质量的RCT，如失访率>20%)
	2c	基于患者结局的研究
	3a	病例对照研究的系统评价
	3b	单个病例对照研究
C	4	病例系列报告、低质量队列研究和低质量病例对照研究
D	5	专家意见(即无临床研究支持的仅依据基础研究或临床经验的推测)

表2 2016年国际心肺移植学会PGD分级

PGD分级	氧合指数(mmHg)	胸部X线表现	体外生命支持
0	任何	正常	无
1	> 300	弥漫性异体移植物浸润/肺水肿	无
2	200~300	弥漫性异体移植物浸润/肺水肿	无
3	< 200	弥漫性异体移植物浸润/肺水肿	无
3	－	弥漫性异体移植物浸润/肺水肿	有
无法分级	－	正常	有

表2 2016年国际心肺移植学会PGD分级

PGD分级	氧合指数(mmHg)	胸部X线表现	体外生命支持
0	任何	正常	无
1	> 300	弥漫性异体移植物浸润/肺水肿	无
2	200~300	弥漫性异体移植物浸润/肺水肿	无
3	< 200	弥漫性异体移植物浸润/肺水肿	无
3	－	弥漫性异体移植物浸润/肺水肿	有
无法分级	－	正常	有

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Guidelines for the diagnosis and management of primary graft dysfunction after lung transplantation

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Guidelines for the diagnosis and management of primary graft dysfunction after lung transplantation