纤维支气管镜在肝移植术后急性肺损伤治疗中的应用

目的 回顾性探讨床旁纤维支气管镜(纤支镜)在肝移植术后急性肺损伤(ALI)治疗中的临床应用价值.方法 将58例肝移植术后各种原因导致的ALI患者按是否采用纤支镜干预治疗分为纤支镜治疗组(36例)和常规治疗组(22例),通过比较两组重症加强治疗病房(ICU)停留时间、机械通气时间、ALI病死率、急性呼吸窘迫综合征(ARDS)进展率及其病死率,以及纤支镜使用前后的动脉血气分析变化等,评价纤支镜治疗肝移植术后ALI的临床疗效.结果 与常规治疗组比较,纤支镜治疗组的ICU停留时间(11±4)d比(16±4)d]、机械通气时间(9±5)d比(14±5)d]均明显缩短(P均＜0.01),ALI病死率(11.1%比36.4%)及ARDS进展率(27.8%比54.5%)明显降低(P＜0.05和P＜0.01),而ARDS病死率无显著变化40.0%(4/10)比66.7%(8/12),P＞0.053;纤支镜治疗后动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、动脉血氧饱和度(SaO2)及氧合指数(PaO2/FiO2)均明显好转,与治疗前比较差异均有统计学意义(P均＜0.01).结论 纤支镜是肝移植术后ALl安全、有效的治疗方法,值得推广.

Experience in the use of bronchofibroscopy in the treatment for acute lung injury after liver transplantation

OBJECTIVE: To evaluate retrospectively the clinical therapeutic effects of the application of bronchofibroscopy(BFS) in the treatment of acute lung injury (ALI) after liver transplantation. METHODS: Fifty-eight patients with ALI caused by various kinds of reasons after liver transplantation were divided into two groups depending on whether the BFS was undertaken (group A, n=36) or not (group B, n=22), and the clinical therapeutic effects were evaluated by comparing the length of intensive care unit (ICU) stay and mechanical ventilation, mortality rate of ALI, morbidity and mortality rate of acute respiratory distress syndrome (ARDS) and changes in arterial blood gas analysis before and after BFS treatment. RESULTS: The length of ICU stay (11+/-4) days vs. (16+/-4) days] and mechanical ventilation (9+/-5) days vs. (14+/-5) days, both P<0.01] in group A were shorter, and mortality rate of ALI (11.1% vs. 36.4%), morbidity rate (27.8% vs. 54.5%, P<0.05 and P<0.01) and mortality rate of ARDS 40.0% (4/10) vs. 66.7% (8/12)] were lower in group A compared with group B (P>0.05). Arterial partial pressure of oxygen (PaO(2)), partial pressure of carbon dioxide (PaCO(2)), arterial oxygen saturation (SaO(2)), and oxygenation index (PaO(2)/FiO(2)) after treatment were much better than those before BFS in group A and the differences were significant (all P<0.01). CONCLUSION: BFS is a kind of safe and effective treatment measure for ALI after liver transplantation and is worthwhile to recommend.