临床肺移植后再灌注损伤中的表面活性剂替代治疗。

Surfactant replacement in reperfusion injury after clinical lung transplantation.

作者信息

Strüber M, Hirt S W, Cremer J, Harringer W, Haverich A

机构信息

Division of Thoracic- and Cardiovascular Surgery, Hannover Medical School, Carl Neuberg Str. 1, 30623 Hannover, Germany.

出版信息

Intensive Care Med. 1999 Aug;25(8):862-4. doi: 10.1007/s001340050967.

DOI:10.1007/s001340050967

PMID:10447548

Abstract

BACKGROUND

Reperfusion injury remains a significant risk factor in the immediate postoperative course after lung transplantation. We report on our initial clinical experience of surfactant replacement in reperfusion injury after clinical lung transplantation.

METHODS AND RESULTS

In 31 consecutive patients, lung (8 single lung, 16 bilateral lung) or heart-lung (7) transplantation was performed. In 6 patients, severe reperfusion injury developed and was treated with continuously nebulized surfactant. Compliance of the allograft increased 40 +/- 25 % within 3 h following treatment with surfactant. Alveolar arterial oxygen gradient decreased by 23 +/- 11 % after 3 h and by 35 +/- 20 % after 6 h. Normal graft function was reestablished within 1-3 days after transplantation. All treated recipients were extubated until the 6th postoperative day. The 30-day mortality for the 31 recipients was 3.3 %, the 1-year survival 84 %.

CONCLUSIONS

Surfactant replacement may become a clinical method for treatment of reperfusion injury after lung transplantation.

摘要

背景

再灌注损伤仍然是肺移植术后早期的一个重要危险因素。我们报告了我们在临床肺移植后再灌注损伤中使用表面活性剂替代治疗的初步临床经验。

方法与结果

连续31例患者接受了肺移植（8例单肺移植，16例双肺移植）或心肺联合移植（7例）。6例患者发生了严重的再灌注损伤，并接受了持续雾化吸入表面活性剂治疗。使用表面活性剂治疗后3小时内，移植肺的顺应性增加了40±25%。3小时后肺泡动脉氧分压差下降了23±11%，6小时后下降了35±20%。移植后1至3天内恢复了正常的移植肺功能。所有接受治疗的受者在术后第6天前均拔除了气管插管。31例受者的30天死亡率为3.3%，1年生存率为84%。