Puskas J D, Winton T L, Miller J D, Scavuzzo M, Patterson G A
Department of Surgery, University of Toronto, Toronto General Hospital, Ontario, Canada.
J Thorac Cardiovasc Surg. 1992 May;103(5):1015-7; discussion 1017-8.
Single lung transplantation remains limited by a severe shortage of suitable donor lungs. Potential lung donors are often deemed unsuitable because accepted criteria (both lungs clear on the chest roentgenogram, arterial oxygen tension greater than 300 mm Hg with an inspired oxygen fraction of 1.0, a positive end-expiratory pressure of 5 cm H2O, and no purulent secretions) do not distinguish between unilateral and bilateral pulmonary disease. Many adequate single lung grafts may be discarded as a result of contralateral aspiration or pulmonary trauma. We have recently used intraoperative unilateral ventilation and perfusion to assess single lung function in potential donors with contralateral lung disease. In the 11-month period ending October 1, 1990, we performed 18 single lung transplants. In four of these cases (22%), the donor chest roentgenogram or bronchoscopic examination demonstrated significant unilateral lung injury. Donor arterial oxygen tension, (inspired oxygen fraction 1.0; positive end-expiratory pressure 5 cm H2O) was below the accepted level in each case (246 +/- 47 mm Hg, mean +/- standard deviation). Through the sternotomy used for multiple organ harvest, the pulmonary artery to the injured lung was clamped. A double-lumen endotracheal tube or endobronchial balloon occlusion catheter was used to permit ventilation of the uninjured lung alone. A second measurement of arterial oxygen tension (inspired oxygen fraction 1.0; positive end-expiratory pressure 5 cm H2O) revealed excellent unilateral lung function in all four cases (499.5 +/- 43 mm Hg; p less than 0.0004). These single lung grafts (three right, one left) were transplanted uneventfully into four recipients (three with pulmonary fibrosis and one with primary pulmonary hypertension). Lung function early after transplantation was adequate in all patients. Two patients were extubated within 24 hours. There were two late deaths, one caused by rejection and Aspergillus infection and the other caused by cytomegalovirus 6 months after transplantation. Two patients are alive and doing well. We conclude that assessment of unilateral lung function in potential lung donors is indicated in selected cases, may be quickly and easily performed, and may significantly increase the availability of single lung grafts.
单肺移植仍然受到合适供肺严重短缺的限制。潜在的肺供体常常被认为不合适，因为目前公认的标准（胸部X线片显示双肺清晰、吸入氧分数为1.0时动脉血氧分压大于300mmHg、呼气末正压为5cmH₂O且无脓性分泌物）并未区分单侧和双侧肺部疾病。许多合适的单肺移植物可能因对侧误吸或肺外伤而被丢弃。我们最近采用术中单侧通气和灌注来评估患有对侧肺部疾病的潜在供体的单肺功能。在截至1990年10月1日的11个月期间，我们进行了18例单肺移植。在其中4例（22%）中，供体胸部X线片或支气管镜检查显示有明显的单侧肺损伤。每例供体的动脉血氧分压（吸入氧分数1.0；呼气末正压5cmH₂O）均低于公认水平（246±47mmHg，均值±标准差）。通过用于多器官获取的胸骨切开术，夹住损伤肺的肺动脉。使用双腔气管内导管或支气管内球囊阻塞导管仅允许未损伤的肺通气。再次测量动脉血氧分压（吸入氧分数1.0；呼气末正压5cmH₂O）显示，所有4例的单肺功能均良好（499.5±43mmHg；p＜0.0004）。这些单肺移植物（3个右肺，1个左肺）顺利移植到4例受者体内（3例患有肺纤维化，1例患有原发性肺动脉高压）。所有患者移植后的早期肺功能均良好。2例患者在24小时内拔除气管插管。有2例晚期死亡，1例死于排斥反应和曲霉菌感染，另1例死于移植后6个月的巨细胞病毒感染。2例患者存活且情况良好。我们得出结论，在某些特定病例中，对潜在肺供体的单肺功能进行评估是必要的，该评估可以快速、简便地进行，并且可能显著增加单肺移植物的可获得性。
