Pilcher D V, Scheinkestel C D, Snell G I, Davey-Quinn A, Bailey M J, Williams T J
Department of Intensive Care Medicine, The Alfred Hospital, Prahran, Australia.
J Thorac Cardiovasc Surg. 2005 Apr;129(4):912-8. doi: 10.1016/j.jtcvs.2004.07.006.
Poor oxygenation might occur in transplanted lungs as a result of reperfusion injury and lack of lymphatic drainage. Low central venous and pulmonary capillary wedge pressures are advocated to reduce pulmonary edema and maximize oxygenation but might adversely affect cardiac index, circulation, and renal function.
Histories, intensive care unit charts, and donor data on 118 lung transplantations performed between 1999 and 2002 were retrospectively assessed. Multiple logistic regression analysis was performed on donor, recipient, operative, and intensive care unit parameters to determine the relationship of filling pressure (central venous and pulmonary capillary wedge pressures) to prolonged mechanical ventilation and outcome. The mean central venous pressure was used to divide patients into high and low central venous pressure groups, which were then compared to determine differences in outcome and complication rates.
A high central venous pressure was found to be associated with prolonged mechanical ventilation (odds ratio, 1.57; 95% confidence interval, 1.13-2.20; P = .008). After removing the effect of poor myocardial function by excluding patients with low cardiac index (< 2.2 L x min -1 x m(-2) ) and high inotrope requirement (> 10 microg/min), central venous pressure remained associated with prolonged mechanical ventilation (odds ratio, 2.31; 95% confidence interval, 1.31-4.07; P = .004). Duration of ventilation (P < .001), intensive care unit mortality (P = .02), hospital mortality (P = .09), and 2-month mortality (P = .02) were higher in patients with central venous pressures of greater than 7 mm Hg. There was no evidence of complications caused by hypovolemia in the low (< or = 7 mm Hg) central venous pressure group, who had lower inotrope requirements (P = .02) and lower creatinine levels (P = .013). Conclusions A high central venous pressure was associated with adverse outcomes after lung transplantation.
再灌注损伤和淋巴引流缺乏可能导致移植肺出现氧合不良。提倡采用低中心静脉压和肺毛细血管楔压来减轻肺水肿并使氧合最大化，但这可能会对心脏指数、循环和肾功能产生不利影响。
回顾性评估1999年至2002年间进行的118例肺移植的病史、重症监护病房图表及供体数据。对供体、受体、手术及重症监护病房参数进行多因素逻辑回归分析，以确定充盈压（中心静脉压和肺毛细血管楔压）与机械通气时间延长及预后的关系。用平均中心静脉压将患者分为高中心静脉压组和低中心静脉压组，然后比较两组的预后及并发症发生率差异。
发现高中心静脉压与机械通气时间延长相关（优势比为1.57；95%置信区间为1.13 - 2.20；P = 0.008）。排除心脏指数低（<2.2 L·min⁻¹·m⁻²）和血管活性药物需求量高（>10 μg/min）的患者以消除心肌功能不良的影响后，中心静脉压仍与机械通气时间延长相关（优势比为2.31；95%置信区间为1.31 - 4.07；P = 0.004）。中心静脉压大于7 mmHg的患者，其通气时间（P < 0.001）、重症监护病房死亡率（P = 0.02）、医院死亡率（P = 0.09）和2个月死亡率（P = 0.02）更高。在中心静脉压低（≤7 mmHg）的组中，没有证据表明存在由血容量不足引起的并发症，该组血管活性药物需求量较低（P = 0.02）且肌酐水平较低（P = 0.013）。结论：肺移植后高中心静脉压与不良预后相关。
