Institute of Anaesthesiology, University Hospital Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland.
Eur J Cardiothorac Surg. 2011 Apr;39(4):538-42. doi: 10.1016/j.ejcts.2010.07.040. Epub 2010 Dec 8.
Lung transplantation has become an established treatment option for end-stage pulmonary diseases. However, outcome depends on preoperative condition and co-morbidity. Furthermore, perioperative blood-product use is known to be associated with worse outcome even in transplant surgery. We investigated the impact of poor preoperative right-ventricular function and blood-product use on outcome after lung transplantation.
The medical records of 169 lung-transplant recipients from 1996 to 2006 were examined. Duration of hospital stay, hours on mechanical ventilation, duration of stay in the intensive care unit, perioperative complications, death during hospital stay, and long-term survival were recorded. These outcome parameters were analyzed regarding coherence with right-ventricular function and the perioperative administration of crystalloids, colloids, allogeneic red blood cells, fresh frozen plasma, and platelets.
Patients with poor preoperative right-ventricular function had a significant increase in postoperative hours on ventilation (p=0.005), intensive care stay (p=0.003), and in-hospital death (p=0.012). The hours on ventilation increased also with high intra-operative fluid administration (p=0.026). Blood-product use was associated with prolonged mechanical ventilation and intensive care stay. After multivariate analysis, transfusion of platelets (p=0.022) was an independent prognostic factor for in-hospital death. Hours of mechanical ventilation was the only independent prognostic factor for long-term mortality (p=0.014).
Perioperative transfusion of platelets is an independent prognostic factor for perioperative mortality. Furthermore, the study indicated that poor preoperative right-ventricular function might worsen perioperatively after lung transplantation. Therefore, pre-transplant treatment of pulmonary hypertension to protract right-ventricular failure and a restrictive use of allogeneic blood products may be options to improve outcome.
肺移植已成为治疗终末期肺部疾病的一种既定方法。然而，其结果取决于术前状况和合并症。此外，围手术期输血产品的使用与移植手术中的不良预后有关。我们研究了术前右心室功能不佳和输血产品的使用对肺移植后结果的影响。
检查了 1996 年至 2006 年间 169 例肺移植受者的病历。记录住院时间、机械通气时间、重症监护病房停留时间、围手术期并发症、住院期间死亡以及长期生存情况。这些结果参数根据与术前右心室功能以及围手术期晶体、胶体、同种异体红细胞、新鲜冷冻血浆和血小板的使用情况进行了分析。
术前右心室功能不佳的患者术后通气时间（p=0.005）、重症监护停留时间（p=0.003）和住院期间死亡率（p=0.012）显著增加。术中液体输注量高也会导致通气时间增加（p=0.026）。输血产品的使用与机械通气和重症监护停留时间延长有关。多变量分析后，血小板输血（p=0.022）是住院期间死亡的独立预后因素。机械通气时间是长期死亡率的唯一独立预后因素（p=0.014）。
围手术期血小板输血是围手术期死亡率的独立预后因素。此外，该研究表明，肺移植后术前右心室功能不佳可能会恶化。因此，肺移植前治疗肺动脉高压以延长右心室衰竭和限制使用同种异体血液制品可能是改善预后的选择。
