CAJ | 학술논문

目的探讨肺移植术后早期的心血管并发症.方法回顾性分析2002年9月至2010年9月接受肺移植的73例终末期肺疾病患者的临床资料.术后受者在重症监护病房行连续有创监测、机械通气及免疫抑制等治疗.观察受者术后至出院期间心血管并发症的发生情况.结果术后早期(术后30 d内)死亡15例,病死率为20.5％,其中死因为肺栓塞2例,心室颤动3例.术后主要并发症包括:心房颤动20例(27.4％),其中阵发性心房颤动19例,持续性心房颤动1例；心房扑动4例(5.5％),其中心房颤动与心房扑动交替发生3例,另1例为持续性心房扑动；心室颤动3例(4.1％)；阵发性室上性心动过速3例(4.1％)；室性心动过速2例(2.7％)；束支传导阻滞8例(11.0％)；室内传导阻滞4例(5.5％)；术后发生左心衰竭4例(5.5％),有心衰竭6例(8.2％)；肺栓塞2例(2.7％)；下肢深静脉血栓1例(1.4％).结论心房颤动是肺移植术后最常见的心律失常,肺栓塞、心室颤动等并发症虽然相对少见,但是一旦发生如不能早期发现及积极治疗则病死率极高.
목적 탐토폐이식술후조기적심혈관병발증.방법 회고성분석2002년9월지2010년9월접수폐이식적73례종말기폐질병환자적림상자료.술후수자재중증감호병방행련속유창감측、궤계통기급면역억제등치료.관찰수자술후지출원기간심혈관병발증적발생정황.결과 술후조기(술후30 d내)사망15례,병사솔위20.5％,기중사인위폐전새2례,심실전동3례.술후주요병발증포괄:심방전동20례(27.4％),기중진발성심방전동19례,지속성심방전동1례；심방복동4례(5.5％),기중심방전동여심방복동교체발생3례,령1례위지속성심방복동；심실전동3례(4.1％)；진발성실상성심동과속3례(4.1％)；실성심동과속2례(2.7％)；속지전도조체8례(11.0％)；실내전도조체4례(5.5％)；술후발생좌심쇠갈4례(5.5％),유심쇠갈6례(8.2％)；폐전새2례(2.7％)；하지심정맥혈전1례(1.4％).결론 심방전동시폐이식술후최상견적심률실상,폐전새、심실전동등병발증수연상대소견,단시일단발생여불능조기발현급적겁치료칙병사솔겁고.
Objective To observe the early cardiovascular complications of patients underwent lung transplantation.Methods The clinical records of 73 patients who underwent lung transplantation in Wuxi People's Hospital from September 2002 to September of 2010 were retrospectively analyzed.All patients were transferred to intensive care unit (ICU) after lung transplantation,received invasive monitoring (PICCO),mechanical ventilation,immunosuppressive therapy and measures to prevent ischemic reperfusion injury.The early cardiovascular complications after lung transplantation up to discharge from hospital were observed.Results The postoperative mortality was 20.5％ (15/73)within 30 days after surgery.Five patients died of cardiovascular reasons including 2 cases of pulmonary embolism and 3 cases of ventricular fibrillation.Cardiovascular complications during the early post-operation period included:paroxysmal atrial fibrillation(19 cases,26.0％) and persist atrial fibrillation(1 case,1.4％); atrial fibrillation and atrial flutter in 3 cases and persistent atrial flutter in 1 patient; ventricular fibrillation (3 cases,4.1％);paroxysmal supraventricular tachycardia(3 cases,4.1％); ventricular tachycardia (2 cases,2.7％);bundle branch block (8 cases,11.0％) ; intraventricular block (4 cases,5.5％) ; left ventricular heart failure(4 cases,5.5％),right heart failure(6 cases,8.2％) ;pulmonary embolism (2 cases,2.7％),deep venous thrombosis(1 case,1.4％).Conclusions Atrial fibrillation is the most common cardiovascular complication post lung transplantation.Pulmonary embolism and ventricular fibrillation are not common but related with high mortality rate post lung transplantation.