单中心50例肺移植临床特点分析

doi:10.3877/cma.j.issn.1674-3903.2020.06.003

中华移植杂志(电子版) ›› 2020, Vol. 14 ›› Issue (06) : 349 -354. doi: 10.3877/cma.j.issn.1674-3903.2020.06.003

所属专题：经典病例；文献；

论著

单中心50例肺移植临床特点分析

陈文慧¹, 郭丽娟¹, 赵丽¹, 梁朝阳¹, 詹庆元², 李敏², 童润², 马千里³, 代华平², 陈静瑜¹^,^†(

), 王辰⁴

^1. 100029　北京，中日友好医院呼吸中心；100029　北京，中日友好医院肺移植科
^2. 100029　北京，中日友好医院呼吸中心；100029　北京，中日友好医院呼吸与危重症医学科
^3. 100029　北京，中日友好医院呼吸中心；100029　北京，中日友好医院胸外科
^4. 100029　北京，中日友好医院呼吸中心；100730　北京，中国医学科学院　北京协和医学院　国家呼吸医学中心

收稿日期:2020-03-22 出版日期:2020-12-25
通信作者: 陈静瑜
基金资助:
中央级公益性科研院所基本科研业务费专项资金项目(2019PT320020)

A single-center experience of 50 cases of adult lung transplantation

Wenhui Chen¹, Lijuan Guo¹, Li Zhao¹, Chaoyang Liang¹, Qingyuan Zhan², Min Li², Run Tong², Qianli Ma³, Huaping Dai², Jingyu Chen¹^,^†(), Chen Wang⁴

^1. Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China; Department of Lung Transplantation, China-Japan Friendship Hospital, Beijing 100029, China
^2. Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China; Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
^3. Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China; Department of Thoracic surgery, China-Japan Friendship Hospital, Beijing 100029, China
^4. Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China; National Clinical Research Center for Respiratory Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China

Received:2020-03-22 Published:2020-12-25
Corresponding author: Jingyu Chen

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引用本文：

陈文慧, 郭丽娟, 赵丽, 梁朝阳, 詹庆元, 李敏, 童润, 马千里, 代华平, 陈静瑜, 王辰. 单中心50例肺移植临床特点分析[J]. 中华移植杂志(电子版), 2020, 14(06): 349-354.

Wenhui Chen, Lijuan Guo, Li Zhao, Chaoyang Liang, Qingyuan Zhan, Min Li, Run Tong, Qianli Ma, Huaping Dai, Jingyu Chen, Chen Wang. A single-center experience of 50 cases of adult lung transplantation[J]. Chinese Journal of Transplantation(Electronic Edition), 2020, 14(06): 349-354.

目的

分析总结肺移植受者围手术期特点，增加肺移植管理经验。

方法

回顾性分析中日友好医院呼吸中心2017年3月1日至12月31日完成的50例脑死亡器官捐献肺移植手术临床资料，受者中位年龄63岁(27～71岁)，男性43例，女性7例；单肺移植31例，双肺移植19例。38例供者中位年龄37岁(16～55岁)，捐献前氧合指数中位数为444 mmHg(313～600 mmHg，1 mmHg＝0.133 kPa)。供受者ABO血型均相合。采用卡方检验或Fisher确切概率法比较不同年龄、性别、术式、体质指数、原发病和术中出血量以及是否应用体外膜肺氧合(ECMO)的受者围手术期死亡比例，两两比较采用Bonferroni法调整α水平。采用Kaplan-Meier法绘制受者术后1年生存曲线，并采用Breslow检验比较两组受者生存曲线是否有差异。P<0.05为差异有统计学意义。

结果

50例肺移植受者中，40例围手术期应用ECMO中位辅助时间为2.0 d(0.3 d～13.0 d)。气管插管呼吸机辅助中位时间为2 d(1～16 d)，ICU停留中位时间为4 d(1～60 d)。50例受者中有8例于围手术期死亡，存活时间1～49 d。双肺移植和单肺移植受者围手术期死亡比例分别为31.6%(6/19)、6.5%(2/31)，差异有统计学意义(P＝0.041)。随访至肺移植术后1年，50例受者存活39例。单肺移植受者术后1年生存率高于双肺移植，分别为87.1%和63.2%，差异有统计学意义(P<0.05)。不同年龄、原发病以及有无ECMO支持的受者术后1年生存率差异均有统计学意义(P均<0.05)。50例肺移植受者中10例发生供者来源感染；9例术后出现气道并发症，均表现为支气管狭窄，其中2例合并吻合口瘘。

结论

选择合适时机行肺移植，并对受者进行围手术期全面综合评估和管理，才能使受者最终受益。

关键词: 肺移植, 围手术期管理, 生存率

Objective

To analyze the perioperative characteristics of lung transplantation (LT) recipients, and to enhance the experience of LT.

Methods

The clinical data on 50 consecutive brain-dead donor at Lung Transplantation Center of China-Japan Friendship Hospital from March 1 to December 31, 2017 were retrospectively collected. The median age of recipients was 63 years (27-71 years), including 43 males and 7 females. Thirty-one single LT (SLT) recipients and 19 bilateral LT (BLT) recipients were enrolled. Thirty-eight donors′ age was between 16 to 55 years (median age 37 years). Median PaO₂/FiO₂ was 444 mmHg (313-600 mmHg, 1 mmHg=0.133 kPa) before donation with ABO compatibility between all donors and recipients. We used Chi-square test or Fisher exact test to compare the perioperative death rate between different groups of age, sex, procedure type, body mass index, primary diseases, blood loss and extracorporeal membrane oxygenation (ECMO) support. Bonferroni method was used to adjust α level in pairwise comparison. Overall survivals of different groups at one year were described by using Kaplan-Meier curves, and Breslow test was used to compare the survival curve between the two groups. A P<0.05 was considered statistically significant.

Results

Median perioperative ECMO support time was 2.0 d (0.3 d-13.0 d) in 40 recipients. Median ICU stay time was 4 d (1-60 d). Perioperative survival rate was 84%(42/50), with survival time being 1-49 d in 8 recipients. Perioperative survival rates in BLT and SLT were 31.6% (6/19) and 6.5% (2/31), respectively (P=0.041). One year survival rate in all recipients was 78% (39/50), while it was 87.1% in SLT and 63.2% in BLT, respectively (P<0.05). There were different Kaplan-Meier curves in subgroup of age, primary diseases and ECMO support (P all <0.05). Ten recipients (20%) had donor derived infection. Nine patients (18%) developed airway complications with bronchial stenosis following LT, which 2 patients complicated with anastomotic fistula.

Conclusion

Patients with end-stage lung disease can benefit from LT at appropriate time point and comprehensive appreciation and management.

Key words: Lung transplantation, Perioperative management, Survival rate

表1 肺移植受者围手术期临床特征分析

因素	亚组	例数	死亡比例[例(%)]	P值
年龄(岁)				0.029
	<35	3	2(67)	0.042(与35～65岁比较)
	35～65	34	3( 9)	0.326(与>65比较)
	>65	13	3(23)	0.214(与<35岁比较)
性别	男性	43	6(14)	0.310
	女性	7	2(29)
肺移植术式	单肺	31	2( 6)	0.041
	双肺	19	6(32)
BMI(kg/m²)				0.314
	<18.5	13	4(31)
	18.5～30.0	36	4(11)
	>30.0	1	0( 0)
原发病				0.014
	ILD	35	4(11)	1.000(与COPD比较)
	COPD	8	0( 0)	0.026(与其他比较)
	其他	7	4(57)	0.017(与ILD比较)
ECMO支持	有	40	8(20)	0.184
	无	10	0( 0)
术中出血量(mL)	<1 000	43	3( 7)	0.071
	≥1 000	7	5(71)

表1 肺移植受者围手术期临床特征分析

因素	亚组	例数	死亡比例[例(%)]	P值
年龄(岁)				0.029
	<35	3	2(67)	0.042(与35～65岁比较)
	35～65	34	3( 9)	0.326(与>65比较)
	>65	13	3(23)	0.214(与<35岁比较)
性别	男性	43	6(14)	0.310
	女性	7	2(29)
肺移植术式	单肺	31	2( 6)	0.041
	双肺	19	6(32)
BMI(kg/m²)				0.314
	<18.5	13	4(31)
	18.5～30.0	36	4(11)
	>30.0	1	0( 0)
原发病				0.014
	ILD	35	4(11)	1.000(与COPD比较)
	COPD	8	0( 0)	0.026(与其他比较)
	其他	7	4(57)	0.017(与ILD比较)
ECMO支持	有	40	8(20)	0.184
	无	10	0( 0)
术中出血量(mL)	<1 000	43	3( 7)	0.071
	≥1 000	7	5(71)

图1 不同年龄肺移植受者术后1年生存曲线

图2 不同原发病肺移植受者术后1年生存曲线

图3 不同术式肺移植受者术后1年生存曲线

图4 有无ECMO支持的肺移植受者术后1年生存曲线

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