Lau Christine L, Patterson G Alexander, Palmer Scott M
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
J Intensive Care Med. 2004 Mar-Apr;19(2):83-104. doi: 10.1177/0885066603261509.
Lung transplantation currently is the preferred treatment option for a variety of end-stage pulmonary diseases. Remarkable progress has occurred through refinements in technique and improved understanding of transplant immunology and microbiology. As a result, recipients are surviving longer after their transplant. Despite improvements in short- and intermediate-term survival, long-term success with lung transplantation remains limited by chronic allograft rejection, also known as bronchiolitis obliterans syndrome. Despite its long-term limitations, lung transplantation remains the only hope for many with end-stage pulmonary disease, and during the past 20 years, it has become increasingly accepted and used. As a result, clinicians working in an intensive care unit (ICU) are more likely to be exposed to these patients both in the immediate postoperative period as well as throughout their remaining lives. It is thus important that the ICU team have a working knowledge of the common complications, when these complications are most likely to occur, and how best to treat them when they do arise. The main focus of this review is to address the variety of potential graft and life-threatening problems that may occur in lung transplant recipients. Because the ICU is also the most common setting where a potential donor is identified, donor issues will briefly be addressed.
目前，肺移植是多种终末期肺部疾病的首选治疗方案。通过技术的改进以及对移植免疫学和微生物学认识的提高，已经取得了显著进展。因此，接受移植的患者术后存活时间更长。尽管短期和中期生存率有所提高，但肺移植的长期成功仍受慢性移植物排斥反应（也称为闭塞性细支气管炎综合征）的限制。尽管存在长期局限性，但肺移植仍是许多终末期肺部疾病患者的唯一希望，在过去20年里，它越来越被接受和应用。因此，在重症监护病房（ICU）工作的临床医生在术后即刻以及患者余生中更有可能接触到这些患者。因此，ICU团队了解常见并发症、这些并发症最可能出现的时间以及出现时的最佳治疗方法很重要。本综述的主要重点是探讨肺移植受者可能出现的各种潜在移植物问题和危及生命的问题。由于ICU也是识别潜在供体最常见的场所，因此将简要讨论供体问题。
