CAJ | 학술논문

目的分析肺移植受者缺血再灌注肺损伤的发生情况及其对肺移植临床效果的影响.方法 2005年8月至2010年12月单中心实施肺移植共28例,符合入选标准者24例.入选者按72h内是否发生缺血再灌注肺损伤分为原发性肺移植功能障碍(PGD)组和非PGD组.统计受者PGD的发生率,按照国际心肺移植协会(ISHLT)的分级标准对PGD进行分级.比较术后不同时间受者PGD分级的差异,分析PGD对术后机械通气时间、重症监护病房住院时间、总住院时间的影响,比较两组受者术后30 d、3个月的存活率及术后1年的肺功能改善程度.结果 24例受者PGD的发生率为66.7％(16/24),其中重度(3级)PGD发生率为46.43％(13/28).肺再灌注0～24 h、24～48 h和48～72 h,受者PGD分级的差异有统计学意义(P＜0.01),重度PGD多发生在肺移植后48 h内.肺移植后30 d内,PGD组重度PGD病死率为6.2％(1/16),非PGD组为0；肺移植后3个月内,PGD组病死率为25.0％(4/16),非PGD组为0；但两个时间点两组病死率的差异均无统计学意义(P＞0.05).PGD组机械通气时间中位数为91.1h,长于非PGD组的19.2h,差异有统计学意义(P＜0.05).两组肺移植后1年内肺功能改善值、6 min步行试验行走距离的差异均无统计学意义(P＞0.05).结论 PGD是肺移植患者早期的主要并发症,其会造成移植患者的机械通气时间延长,有可能影响肺移植的早期和远期效果.
목적 분석폐이식수자결혈재관주폐손상적발생정황급기대폐이식림상효과적영향.방법 2005년8월지2010년12월단중심실시폐이식공28례,부합입선표준자24례.입선자안72h내시부발생결혈재관주폐손상분위원발성폐이식공능장애(PGD)조화비PGD조.통계수자PGD적발생솔,안조국제심폐이식협회(ISHLT)적분급표준대PGD진행분급.비교술후불동시간수자PGD분급적차이,분석PGD대술후궤계통기시간、중증감호병방주원시간、총주원시간적영향,비교량조수자술후30 d、3개월적존활솔급술후1년적폐공능개선정도.결과 24례수자PGD적발생솔위66.7％(16/24),기중중도(3급)PGD발생솔위46.43％(13/28).폐재관주0～24 h、24～48 h화48～72 h,수자PGD분급적차이유통계학의의(P＜0.01),중도PGD다발생재폐이식후48 h내.폐이식후30 d내,PGD조중도PGD병사솔위6.2％(1/16),비PGD조위0；폐이식후3개월내,PGD조병사솔위25.0％(4/16),비PGD조위0；단량개시간점량조병사솔적차이균무통계학의의(P＞0.05).PGD조궤계통기시간중위수위91.1h,장우비PGD조적19.2h,차이유통계학의의(P＜0.05).량조폐이식후1년내폐공능개선치、6 min보행시험행주거리적차이균무통계학의의(P＞0.05).결론 PGD시폐이식환자조기적주요병발증,기회조성이식환자적궤계통기시간연장,유가능영향폐이식적조기화원기효과.
Objective Primary graft dysfunction (PGD) is a severe form of ischemia-reperfusion injury (IRI) developing in the early days of post-lung transplantation (LT).We aimed to investigate the incidence and severity grading of PGD,and analyze the impact of PGD on early morbidity and mortality after LT as well as on long-term function and survival.Method Twenty-eight consecutive recipients undergoing LT were collected at Beijing Chao-Yang Hospital between Aug.2005 and Dec.2010,and 24 LT recipients were enrolled in this study.The incidence of PGD was calculated and the recipients were classified by standardized consensus criteria reported by the International Society for Heart and Lung Transplantation (ISHLT) Working Group on PGD.The difference was compared among T0-24,T24-48 and T48-72.The incidence of PGD,PGD grading and impact of PGD on early morbidity and mortality after LT as well as on long-term function and survival were analyzed.Result The incidence of PGD after LT was 66.7％ (16/24).The incidence of severe PGD (grading 3) was 54.2％ (13/24).There was significant difference among T0-24,T24-48 and T48-72 in the severity grading of PGD (P＜0.01).At 30th day and 3rd month post-LT,one and 4 died,respectively,among LT recipients with PGD.There was no death in LT recipients without PGD.The all-cause mortality rate had no statistically significant difference between the two groups (P ＞ 0.05).The median duration of mechanical ventilation in LT recipients with or without PGD was 91.1 h and 19.2 h respectively (P＜0.05).The improvements of pulmonary function and 6 Minute Walk Test (6MWT) within one year after LT showed no statistically significant difference between LT recipients with PGD and those without PGD (P ＞ 0.05 ). Conclusion MBL gene single nucleotide polymorphisms may influence CMV infection after HSCT.