Division of Pulmonary and Critical Care, Department of Medicine, University of California San Francisco School of Medicine, San Francisco, Calif.
Division of Pulmonary and Critical Care, Department of Medicine, University of California San Francisco School of Medicine, San Francisco, Calif.
J Thorac Cardiovasc Surg. 2018 Jul;156(1):440-448.e2. doi: 10.1016/j.jtcvs.2018.01.101. Epub 2018 Feb 22.
Extracorporeal membrane oxygenation (ECMO) is increasingly used as a bridge to lung transplantation. The impact of preoperative ECMO on health-related quality of life (HRQL) and depressive symptoms after lung transplantation remains unknown, however.
In a single-center prospective cohort study, we assessed HRQL and depressive symptoms before and at 3, 6, and 12 months after lung transplantation using the Short Form 12 Physical and Mental Component Scores (SF12-PCS and SF12-MCS), Airway Questionnaire 20-Revised (AQ20R), EuroQol 5D (EQ5D), and Geriatric Depression Scale (GDS). Changes in HRQL were quantified by segmented linear mixed-effects models controlling for age, sex, diagnosis, preoperative forced expiratory volume in 1 second, 6-minute walk distance, and Lung Allocation Score. We compared changes in HRQL among subjects bridged with ECMO, subjects hospitalized but not on ECMO, and subjects called in for transplantation as outpatients.
Out of 189 subjects, 17 were bridged to transplantation with ECMO. In all groups, improvements in HRQL following lung transplantation exceeded the minimally clinically important difference using the SF12-PCS, AQ20R, EQ5D, and GDS. HRQL defined by SF12-MCS did not change after transplantation. Improvements were generally similar among the groups, except for EQ5D, which showed a trend toward less benefit in the outpatients, possibly due to their better HRQL before lung transplantation.
Subjects ill enough to require ECMO as a bridge to lung transplantation appear to achieve similar improvements in HRQL and depressive symptoms as those who do not. It is reassuring to both providers and patients that lung transplantation provides substantial improvements in HRQL, even for those patients who are critically ill in the run up to transplantation.
体外膜肺氧合（ECMO）越来越多地被用作肺移植的桥接治疗。然而，术前 ECMO 对肺移植后健康相关生活质量（HRQL）和抑郁症状的影响尚不清楚。
在一项单中心前瞻性队列研究中，我们使用 12 项简短健康调查量表（SF12-PCS 和 SF12-MCS）、气道问卷 20 修订版（AQ20R）、欧洲五维健康量表（EQ5D）和老年抑郁量表（GDS），在肺移植前、移植后 3、6 和 12 个月评估 HRQL 和抑郁症状。通过分段线性混合效应模型控制年龄、性别、诊断、术前 1 秒用力呼气量、6 分钟步行距离和肺分配评分，量化 HRQL 的变化。我们比较了 ECMO 桥接组、未接受 ECMO 住院组和门诊预约移植组之间 HRQL 的变化。
在 189 名患者中，有 17 名患者接受 ECMO 桥接移植。在所有组中，肺移植后 HRQL 的改善均超过 SF12-PCS、AQ20R、EQ5D 和 GDS 的最小临床重要差异。SF12-MCS 定义的 HRQL 在移植后没有改变。除 EQ5D 外，各组之间的改善大致相似，这可能是由于门诊患者移植前 HRQL 较好，因此门诊患者的获益趋势较低。
需要 ECMO 作为肺移植桥接治疗的患者，其 HRQL 和抑郁症状的改善似乎与未接受 ECMO 治疗的患者相似。这对于提供者和患者来说都是令人安心的，因为肺移植可以显著改善 HRQL，即使是那些在移植前病情危重的患者。
