肺移植后影响患者长期生存的危险因素

背景:国内肺移植开展数量较少,移植后长期生存时间较其他器官移植短,其原因尚不完全清楚。目的:分析影响肺移植后患者长期生存因素。方法:回顾分析61例终末期肺疾病患者接受肺移植的临床资料,根据随访生存时间将患者分为两组。观察组生存时间>3年29例,对照组生存时间<1年32例,对两组患者的一般特征、术式(单、双肺移植)、肺动脉压力、是否应用体外膜氧合等进行多因素逻辑回归分析比较。结果与结论:统计学分析显示,年龄(≥50岁)、肺移植前肺动脉高压、急性排斥和肺部严重感染是影响患者肺移植后长期生存的独立风险因素。提示肺移植治疗终末期肺病,选择合适肺移植患者,移植前控制肺动脉压,移植中严格把握体外膜氧合转流适应证,移植后预防肺部感染,严格免疫抑制剂治疗是延长患者生存时间重要措施。

Risk factors for the long-term survival of patients after lung transplantation

BACKGROUND:The number of lung transplantation cases in China is few,and the reason why the survival time after lung transplantation is shorter than that after other organ transplantation is unclear.OBJECTIVE:To estimate the influence factors of long-term survival after lung transplantation.METHODS:A retrospective analysis on the clinical data of 61 cases of patients with end-stage lung disease was preformed after lung transplantation.The patients were divided into two groups according to the survival time of follow-up.The survival time of observation group (n=29) was over 3 years and the control group (n=32) was less than 1 year.The general characteristics of patients,surgical (single or double lung transplantation),pulmonary artery pressure,application of extracorporeal membrane oxygenation were compared by muhivariable logistic regression model.RESULTS AND CONCLUSION:Statistics analysis confirmed that age (≥ 50 years),pulmonary hypertension before lung transplantation,acute rejection and severe pulmonary infection are the independent risk factors that could influence the long-term survival of patients after lung transplantation.As for end-stage lung disease treated with lung transplantation,the selection of favorable patients,reducing mean pulmonary artery pressure preoperatively,use of extracorporeal membrane oxygenation during transplantation,precaution of pulmonary infection after transplantation and strict immunosuppressive therapy are the important measures to prolong the survival time of the patients.