Zhu Yan-hong, Chen Jing-yu, Zheng Ming-feng, Hu Chun-xiao, He Yi-jun, Wang Yong-gong
Lung Transplantation Group, Wuxi Fifth Hospital, Wuxi Thoracic Hospital, Wuxi 214073, Jiangsu, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2006 Jul;18(7):394-6.
To evaluate monitoring and cares in the intensive care unit (ICU) after lung transplantation.
From September 2002 to April 2005, there were 18 cases of lung transplant recipients, who had suffered from emphysema (9 cases), pulmonary fibrosis (5 cases), silicosis (1 cases), bronchiectasis (1 case), pulmonary vascular leiomyoma (1 case), ventricular septal defect and Eisenmenger's syndrome (1 case), respectively. Operative procedures included 9 cases with left lung transplantation, 5 right lung transplantation, 1 case right single lung transplantation and ventricular septal defect repair, and 3 cases bilateral lung transplantations. All the patients received mechanical ventilation, immunosuppressive agents, antibacterial prophylaxis, and prevention of reperfusion injury in the ICU after operation. Preoperatively, echocardiography (ECHO), artery blood gas,and oxygenation index (partial pressure of oxygen in artery/fraction of inspired oxygen, PaO(2)/FiO(2)) were observed.
The average weaning time from the ventilator was (7.39+/-4.89) days. The average ICU stay time was (9.72+/-8.32) days. The systolic pulmonary artery pressure (Ppa, syst) was monitored with Swan-Ganz catheterization 1 week post transplant, and it was found to have decreased significantly from (48.94+/-14.45) mm Hg (1 mm Hg=0.133 kPa) to (39.59+/-7.45) mm Hg (P<0.05). At the same time, oxygenation index was improved from (263.89+/-82.09) mm Hg to (345.56+/-92.18) mm Hg (P<0.05), partial pressure of carbon dioxide in artery (PaCO(2)) was decreased from (63.29+/-22.56) mm Hg to (38.37+/-9.19) mm Hg (P<0.05). In hospital mortality (HM) was 16.7% (3/18 cases), and an early death was due to severe infection on the 30 th postoperative day in 1 patient and acute rejection on the 15 th postoperative day in another patient, and the other patient died due to pulmonary vein embolism on the 36 th day. Fifteen patients recovered quickly and discharged from the hospital. One patient was followed up for 32 months.
Lung transplantation remains the only hope for many patients with end stage pulmonary disease. It is important that the lung transplant team possesses a working knowledge of the treatment of common complications, the time of these complications mostly likely to occur and how best to treat them when they do arise, to ensure long-term survival and success.
评估肺移植术后重症监护病房（ICU）的监测与护理。
2002年9月至2005年4月，18例肺移植受者，分别患有肺气肿（9例）、肺纤维化（5例）、矽肺（1例）、支气管扩张（1例）、肺血管平滑肌瘤（1例）、室间隔缺损合并艾森曼格综合征（1例）。手术方式包括左肺移植9例、右肺移植5例、右单肺移植并室间隔缺损修补1例、双侧肺移植3例。所有患者术后在ICU接受机械通气、免疫抑制剂、抗菌预防及再灌注损伤预防治疗。术前观察超声心动图（ECHO）、动脉血气及氧合指数（动脉血氧分压/吸入氧分数，PaO₂/FiO₂）。
呼吸机平均撤机时间为（7.39±4.89）天。ICU平均住院时间为（9.72±8.32）天。移植后1周用Swan - Ganz导管监测收缩期肺动脉压（Ppa，syst），发现其从（48.94±14.45）mmHg（1mmHg = 0.133kPa）显著降至（39.59±7.45）mmHg（P<0.05）。同时，氧合指数从（263.89±82.09）mmHg升至（345.56±92.18）mmHg（P<0.05），动脉血二氧化碳分压（PaCO₂）从（63.29±22.56）mmHg降至（38.37±9.19）mmHg（P<0.05）。院内死亡率（HM）为16.7%（3/18例），1例患者术后第30天因严重感染早期死亡，另1例患者术后第15天因急性排斥反应死亡，另1例患者术后第36天因肺静脉栓塞死亡。15例患者恢复迅速并出院。1例患者随访32个月。
肺移植仍是许多终末期肺病患者的唯一希望。肺移植团队掌握常见并发症的治疗方法、这些并发症最可能发生的时间以及出现时的最佳治疗方法，对于确保患者长期存活及手术成功至关重要。
