Clinical application of ex vivo lung perfusion technique
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摘要: 肺移植是治疗多种终末期肺病的有效手段, 但供肺短缺严重限制了肺移植的发展。离体肺灌注技术(EVLP)能再次评估和改善供肺肺功能, 提高供肺的利用率, 目前在欧美国家逐步开始应用, 取得了较好的临床效果。本文总结了肺移植供肺选择标准、EVLP适应证、EVLP的类型以及国外应用现状, 同时介绍了无锡市人民医院EVLP初步经验, 以期为同行提供参考。
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表 1 3种EVLP的技术指标[14]
Table 1. Technical indicators of three kinds of EVLP
指标 Toronto技术 Lund技术 OCSTM技术 灌注 目标流量 40%CO(1 h) 100%CO(1 h) 2.0~2.5 L/min (15~30 min) 开始流量 目标流量的10% 100 mL/min 200 mL/min 灌流特点 持续式 持续式 搏动式 肺动脉压力(mmHg) ≤15 ≤20 ≤20 左房状态 闭合 开放 开放 左房压力(mmHg) 3~5 0 0 灌注液 Steen液 Steen液+红细胞压积(0.14) OCSTM液+红细胞压积(0.15~0.25) 机械通气 开始温度(℃) 32 32 34 潮气量(mL/kg) 7 5~7 6 频率(次/分) 7 20 10 PEEP(cmH2O) 5 5 5~7 FiO2(%) 21 50 21 EVLP时间点 EVLP开始 固定装置 固定装置 移动装置 灌注时间 4~6 h, 最长12 h 2 h 转运期间持续灌注 CO为心排出量 -
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