肺移植研究现状及移植期的规范化管理

肺移植是终末期肺疾病患者唯一的治疗手段,该领域也是目前国际范围内的研究热点。相关研究既促进了肺移植的进步与发展,也改善了移植后患者的生活质量。随着肺移植技术的发展,适应人群相关指南不断修订,供体肺来源也一直是所有移植中心亟待解决的问题。移植期的规范化管理涉及麻醉诱导、术中液体管理、气道管理、重要步骤的处理及术后疼痛管理等方面。体外生命支持(ECLS)包括体外循环(CPB)及体外膜肺氧合(ECMO)。随着ECLS技术的发展,ECMO作为肺移植桥梁在术中及术后循环支持中的优更加突出,帮助受体患者顺利度过肺移植窗口期。虽然肺移植在基础科学和临床研究方面都有许多进展,但要提高移植后的生存率,还须克服包括如何成功完成肺移植、扩大肺供体库、诱导耐受、预防移植后并发症、原发性移植物功能障碍(PGD)、细胞和抗体介导的排斥反应以及感染等在内的诸多问题。

Research status of lung transplantation and standardized management during transplantation period

Lung transplantation is the only treatment for patients with end-stage lung diseases.And this field is also a research hotspot in the international field at presen.Relevant researches not only promote the progress and development of lung transplantation,but also improve the life quality of patients after transplantation.With the development of lung transplantation technology,the guidelines for identifying candidates are constantly being revised,and the source of donor lungs has always been an urgent problem for all transplantation centers.The standardized management during transplantation period involves anesthesia induction,intraoperative fluid management,airway management,management of important operative steps and postoperative pain management.Extracorporeal life support(ECLS)includes cardiopulmonary bypass(CPB)and extracorporeal membrane oxygenation(ECMO).With the progress and development of ECLS technology,the advantages of ECMO as a bridge for lung transplantation,intraoperative and postoperative circulatory support are becoming more and more prominent,enabling recipient patients to successfully pass the period of lung transplantation.Although lung transplantation in basic science and clinical researches has got a lot of progress,to improve the survival rate after transplantation,we must overcome many challenges including how to successfully perform lung transplantation,expand lung donor library,induce tolerance,and prevent complications after transplantation,primary graft dysfunction(PGD),cell and antibody mediated rejection and infection.