Novick R J, Ahmad D, Menkis A H, Reid K R, Pflugfelder P W, Kostuk W J, McKenzie F N
Division of Cardiovascular-Thoracic Surgery, University Hospital, London, Ontario, Canada.
J Thorac Cardiovasc Surg. 1991 Apr;101(4):643-8.
The results of heart-lung transplantation are improving with increasing experience in postoperative management, but obliterative bronchiolitis may still develop late postoperatively. We have performed 19 heart-lung transplants, with 1-month, 1-year, and 2-year actuarial survival rates of 95% +/- 5%, 84% +/- 8%, and 69% +/- 16%, respectively. Three early recipients died of bronchiolitis, and four patients who were operated on more than 2 years ago are currently being followed up with bronchiolitis. Since August 1988, 13 surviving recipients have undergone serial postoperative bronchoscopies and transbronchial biopsies with topical analgesia. Diffuse bronchomalacia, involving the main bronchi down to the fifth-order bronchi bilaterally, has developed in four patients with bronchiolitis 9 +/- 2 months after the diagnosis of bronchiolitis was confirmed. Pulmonary function tests have revealed a lower ratio of forced expiratory volume in 1 second to forced vital capacity, lower specific airway conductance, and higher airway resistance in heart-lung recipients with bronchomalacia than in patients with bronchiolitis alone. We conclude that diffuse bronchomalacia occurs frequently in heart-lung transplant recipients who have obliterative bronchiolitis. Bronchomalacia worsens the functional airflow obstruction caused by bronchiolitis and may play an important role clinically in the declining respiratory status of heart-lung transplant recipients.
随着心肺移植术后管理经验的增加，其结果正在改善，但闭塞性细支气管炎仍可能在术后晚期发生。我们已进行了19例心肺移植手术，1个月、1年和2年的精算生存率分别为95%±5%、84%±8%和69%±16%。3例早期受者死于细支气管炎，4例在2年多前接受手术的患者目前正因细支气管炎接受随访。自1988年8月以来，13例存活受者在局部麻醉下接受了系列术后支气管镜检查和经支气管活检。4例确诊细支气管炎9±2个月后的患者出现了弥漫性支气管软化，累及双侧主支气管直至五级支气管。肺功能测试显示，与单纯患有细支气管炎的患者相比，患有支气管软化的心肺移植受者1秒用力呼气量与用力肺活量的比值更低、比气道传导率更低、气道阻力更高。我们得出结论，弥漫性支气管软化在患有闭塞性细支气管炎的心肺移植受者中频繁发生。支气管软化会使由细支气管炎引起的功能性气流阻塞恶化，并可能在临床上对心肺移植受者呼吸状况的下降起重要作用。
