肺移植围术期治疗3例的经验和教训

目的 提高同种异体肺移植的治疗效果.方法 总结分析3例同种异体肺移植围术期治疗的经验和教训.结果 例1术后43 h撤离呼吸机,第4天移植肺细菌感染,第7天出现急性排斥反应,第14天因"右侧凝固性血胸"再次行右胸凝血块清除.例2术后48 h撤离呼吸机,第3天、第5天因左右胸腔先后出现活动性出血而再次剖胸止血,第6天出现急性排斥反应,第14天、第30天移植肺先后细菌、真菌感染.例3双肺移植术后并发桥脑中央髓鞘溶解症.结论 充分的术前准备和正确的围术期处理是肺移植成功的关键,重点是防治移植肺的早期失功能和围术期感染,同时早期监测急性排斥反应.

The Perioperative Management of Lung Transplantation(Reports of 3 Cases)

Objective To summarize of allogenic lung transplantation. Methods To evaluate the perioperative management of 3 cases allogenic lung transplantation. Results The first case was successfully gotten off ventilator 43 hours after the operation. The transplanted lung was susceptible to bacterial infection on the 4th day, released at 75 d. Acute allograft rejection was occurred on the 7th days after operation. Clotted hemothorax was visualized on the computed tomography scan, then video-assistant thoracoscope was used for early evacuation of clotted hemothorax on the 14th day. The second one was successfully gotten off ventilator 48 hours after the operation. Postoperative hemothoraxs were respectively encountered and required reoperation in left side of thoracic cavity 3 days later and right side 4 days later. Acute allograft rejection was occurred on the 6th day. The transplanted lung was susceptible to bacterial infection on the 14th day and fungal infection on the 30th day and released at 76 d. The third one was complicated by central pontine myelinolysis after lung transplantation. Conclusion Sufficient and corrective perioperative management play a major role in the long-term survival of lung transplantation recipient. Detail attention to the early graft disfunction and perioperative infection, associated with early identification of acute rejection, are important in ensuring an successful outcome.