肺移植术后早期死亡原因分析

目的探讨肺移植术后早期的死亡原因及其预防和处理。方法2002年9月至2005年12月共完成肺移植30例,其中慢性阻塞性肺气肿12例、肺纤维化10例、淋巴管肌瘤病1例、矽肺1例、支气管扩张伴囊肿3例、Eisenmenger综合征3例;单肺移植23例、体外循环下室间隔缺损修补后行右肺移植3例、非体外循环下序贯式双肺移植3例,体外循环下序贯式双肺移植1例。术后带气管插管入ICU行连续有创监测及机械通气、免疫抑制治疗,预防感染和再灌注损伤等并发症。结果术后早期死亡6例（20％）,其中感染3例、原发性移植肺失功（PGD）1例、排斥1例、肺栓塞1例。结论感染、原发性移植物失功、排斥、肺栓塞等是肺移植早期常见的死亡原因。

Causes of early death after lung transplant: analysis of 30 cases

OBJECTIVE: To investigate the causes of early death after lung transplant and its prevention and management. METHODS: Lung transplantation was performed on 30 patients, 12 with chronic obstructive pulmonary disease, 10 with pulmonary fibrosis, 3 with Eisenmenger's syndrome, 3 with bronchiectasis, 1 with pneumosilicosis, and 1 with pulmonary vascular leiomyoma, 24 males and 6 females, aged 48 +/- 13 (15 - 72), 23 undergoing single lung transplantation, 3 undergoing right single lung transplantation following ventricular septal defect repair with CPB, 3 undergoing bilateral sequential lung transplantation without CPB, and 1 case undergoing bilateral sequential lung transplantation with CPB, during the period September 2002 to December 2005. All the patients received invasive monitoring, mechanical ventilation, immunosuppressive agents, antibacterial prophylaxis, and prevention of reperfusion injury in ICU after operation. RESULTS: Six cases died in the early period with the causes of death (n = 3), primary graft dysfunction (PGD) (n = 1), acute rejection (n = 1), and pulmonary infarction (n = 1). CONCLUSION: Infection, PGD, acute rejection and pulmonary infarction represent the most frequent causes of early death after lung transplantation.