Singh H, Bossard R F
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas 75235-9068, USA.
Can J Anaesth. 1997 Mar;44(3):284-99. doi: 10.1007/BF03015367.
Five thousand, two hundred and eight lung transplants were performed worldwide before April, 1996. This review will discuss lung transplantation from an historical perspective, its indications, donor and recipient selection criteria, donor lung preparation, surgical considerations, perioperative anaesthetic management, and associated morbidity and mortality.
Recent literature on perioperative anaesthetic management of lung transplantation and experience from international centres including the Toronto Lung Transplant Group and the St. Louis Lung Transplant Group.
Lung transplantation comprises of a family of operations, including single lung transplant, bilateral single lung transplant, lobar transplant and block heart-lung transplant. Improved donor lung preservation techniques have increased the duration of cold ischaemic time. The advent of bilateral single lung transplant has decreased the requirement for cardiopulmonary bypass, and airway complications have been reduced by adoption of the telescoping bronchial anastomoses. Advances in perioperative monitoring (including transoesophageal echocardiography), pulmonary vasodilators (e.g., nitric oxide and prostaglandin E1), cardiopulmonary bypass and ventilatory management, and a better understanding of the pathophysiological processes during the procedure have improved perioperative anaesthetic management. Also, advances in broad spectrum antibiotics and immunosuppressant drugs have improved the outcome by better management of the complications of infection and rejection.
Lung transplantation improves the quality of life with marginal improvement in life expectancy of the recipients. It is an expensive procedure requiring continued resources for long term management of these patients.
1996年4月前，全球共进行了5208例肺移植手术。本综述将从历史角度探讨肺移植，包括其适应证、供体和受体选择标准、供肺准备、手术注意事项、围手术期麻醉管理以及相关的发病率和死亡率。
关于肺移植围手术期麻醉管理的近期文献以及包括多伦多肺移植组和圣路易斯肺移植组在内的国际中心的经验。
肺移植包括一系列手术，如单肺移植、双侧单肺移植、肺叶移植和整块心肺移植。改进的供肺保存技术延长了冷缺血时间。双侧单肺移植的出现减少了体外循环的需求，采用套叠式支气管吻合术减少了气道并发症。围手术期监测（包括经食管超声心动图）、肺血管扩张剂（如一氧化氮和前列腺素E1）、体外循环和通气管理的进展，以及对手术过程中病理生理过程的更好理解，改善了围手术期麻醉管理。此外，广谱抗生素和免疫抑制药物的进展通过更好地管理感染和排斥反应并发症改善了预后。
肺移植改善了受者的生活质量，对其预期寿命有一定程度的延长。这是一项昂贵的手术，需要持续的资源用于这些患者的长期管理。
