留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

肺移植术后机械通气延长的危险因素分析

王大鹏, 李小杉, 轩晨昊, 等. 肺移植术后机械通气延长的危险因素分析[J]. 器官移植, 2022, 13(6): 797-802. doi: 10.3969/j.issn.1674-7445.2022.06.016
引用本文: 王大鹏, 李小杉, 轩晨昊, 等. 肺移植术后机械通气延长的危险因素分析[J]. 器官移植, 2022, 13(6): 797-802. doi: 10.3969/j.issn.1674-7445.2022.06.016
Wang Dapeng, Li Xiaoshan, Xuan Chenhao, et al. Analysis of risk factors of prolonged mechanical ventilation after lung transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(6): 797-802. doi: 10.3969/j.issn.1674-7445.2022.06.016
Citation: Wang Dapeng, Li Xiaoshan, Xuan Chenhao, et al. Analysis of risk factors of prolonged mechanical ventilation after lung transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(6): 797-802. doi: 10.3969/j.issn.1674-7445.2022.06.016

肺移植术后机械通气延长的危险因素分析

doi: 10.3969/j.issn.1674-7445.2022.06.016
基金项目: 

江苏省科技计划专项资金 BE2022697

无锡市卫生健康委科研项目 Q202003

详细信息
    作者简介:
    通讯作者:

    许红阳,博士,主任医师,研究方向为肺移植围手术期管理,Email:xhy1912@aliyun.com

  • 中图分类号: R617

Analysis of risk factors of prolonged mechanical ventilation after lung transplantation

More Information
  • 摘要:   目的  探讨肺移植受者术后机械通气延长(PMV)的危险因素。  方法  回顾性分析90例肺移植受者的临床资料。根据术后有创机械通气时间分为PMV组(通气时间 > 48 h,30例)和对照组(通气时间≤48 h,60例)。比较两组受者围手术期相关指标,包括术前指标[血清肌酐、估算肾小球滤过率(eGFR)],术中指标(供肺冷缺血时间、出血量),术后指标[首次红细胞、白细胞、血小板计数、血红蛋白、C-反应蛋白、血清肌酐、总胆红素、丙氨酸转氨酶(ALT)、氧合指数、eGFR、入重症监护室(ICU)平均动脉压]。采用多因素logistic层次回归分析肺移植受者术后PMV的危险因素。  结果  PMV组受者术前血清肌酐为62(53,67)μmol/L,高于对照组受者的57(47,62)μmol/L;PMV组受者术前eGFR为97(93,107)mL/min,低于对照组受者的106(102,116)mL/min;PMV组受者术后首次氧合指数为196(157, 286)mmHg,低于对照组受者的250(199,354)mmHg(均为P < 0.05)。多因素分析显示术后首次总胆红素升高、术后首次氧合指数和术前eGFR降低是肺移植术后PMV的独立危险因素。  结论  术后首次总胆红素升高、术后首次氧合指数和术前eGFR降低是肺移植术后PMV的独立危险因素。

     

  • 表  1  两组受者围手术期相关指标的比较

    Table  1.   Comparison of perioperative indexes of recipients between the two groups[M(P25, P75)]

    指标 对照组(n=60) PMV组(n=30) P
    术前指标
      血清肌酐(μmol/L) 57(47,62) 62(53,67) 0.026
      eGFR(mL/min) 106(102,116) 97(93,107) 0.001
    术中指标
      供肺冷缺血时间(min) 515(420,598) 470(379,562) 0.072
      出血量(mL) 1 000(800,1 500) 1 150(800,1 500) 0.322
    术后指标
      首次红细胞(×1012/L) 4(3,4) 4(3,4) 0.976
      首次白细胞(×109/L) 12(8,16) 11(7,15) 0.344
      首次血小板计数(×109/L) 138(116,174) 130(94,156) 0.153
      首次血红蛋白(g/L) 110(100,122) 109(102,122) 0.834
      首次C-反应蛋白(mg/L) 7(4,15) 6(3,16) 0.722
      首次血清肌酐(μmol/L) 55(47,66) 57(45,65) 0.894
      首次总胆红素(μmol/L) 28(22,36) 40(22,50) 0.055
      首次ALT(U/L) 30(21,34) 24(19,33) 0.200
      首次氧合指数(mmHg) 250(199,354) 196(157,286) 0.008
      首次eGFR(mL/min) 103(97,113) 102(91,115) 0.480
      入ICU平均动脉压(mmHg) 84(73,96) 79(72,86) 0.202
    下载: 导出CSV

    表  2  模型拟合的评价分析

    Table  2.   Evaluation and analysis of model fitting

    模型 离差 AIC BIC 模型对比
    对比模型 χ2 P
    1 109.3 113 118
    2 102.4 108 116 1-2 6.911 0.009
    3 96.8 105 115 2-3 5.6 0.018
    4 96.4 106 119 3-4 0.363 0.547
    5 94.5 107 122 4-5 1.93 0.165
    注:①AIC为赤池信息准则。
    ②BIC为贝叶斯信息准则。
    下载: 导出CSV

    表  3  肺移植术后PMV危险因素的多因素logistic回归分析结果

    Table  3.   Multivariate logistic regression analysis of PMV risk factors after lung transplantation

    预测变量 系数 标准误 Z P 比值比 95% CI
    术后首次总胆红素 0.043 20 0.019 34 2.23 0.026 1.044 1.005~1.084
    术后首次氧合指数 -0.005 87 0.002 80 -2.10 0.036 0.994 0.989~0.999
    术前eGFR -0.046 12 0.020 52 -2.25 0.025 0.955 0.917~0.994
    注:①系数表示“是否通气时间延长= 1”与“是否通气时间延长= 0”相比的对数比。
    下载: 导出CSV
  • [1] ROSE L, MCGINLAY M, AMIN R, et al. Variation in definition of prolonged mechanical ventilation[J]. Respir Care, 2017, 62(10): 1324-1332. DOI: 10.4187/respcare.05485.
    [2] MCCORT M, MACKENZIE E, PURSELL K, et al. Bacterial infections in lung transplantation[J]. J Thorac Dis, 2021, 13(11): 6654-6672. DOI: 10.21037/jtd-2021-12.
    [3] JOEAN O, WELTE T, GOTTLIEB J. Chest infections after lung transplantation[J]. Chest, 2022, 161(4): 937-948. DOI: 10.1016/j.chest.2021.10.014.
    [4] CAO S, TENNAKOON L, BRUBAKER AL, et al. Infection with two multi-drug-resistant organisms in solid organ transplant patients is associated with increased mortality and prolonged hospitalization[J]. Surg Infect (Larchmt), 2022, 23(4): 394-399. DOI: 10.1089/sur.2021.300.
    [5] FISHMAN JA. Infection in organ transplantation[J]. Am J Transplant, 2017, 17(4): 856-879. DOI: 10.1111/ajt.14208.
    [6] DI NARDO M, TIKKANEN J, HUSAIN S, et al. Postoperative management of lung transplant recipients in the intensive care unit[J]. Anesthesiology, 2022, 136(3): 482-499. DOI: 10.1097/ALN.0000000000004054.
    [7] BENNETT D, FOSSI A, MARCHETTI L, et al. Postoperative acute kidney injury in lung transplant recipients[J]. Interact Cardiovasc Thorac Surg, 2019, 28(6): 929-935. DOI: 10.1093/icvts/ivy355.
    [8] CLARK NM, WEIGT SS, FISHBEIN MC, et al. Fungal infections complicating lung transplantation[J]. Semin Respir Crit Care Med, 2018, 39(2): 227-254. DOI: 10.1055/s-0037-1617443.
    [9] LEASE ED, BUDEV MM. Infectious complications in lung transplant recipients[J]. Thorac Surg Clin, 2022, 32(2): 211-220. DOI: 10.1016/j.thorsurg.2021.12.002.
    [10] PAGLICCI L, BORGO V, LANZARONE N, et al. Incidence and risk factors for respiratory tract bacterial colonization and infection in lung transplant recipients[J]. Eur J Clin Microbiol Infect Dis, 2021, 40(6): 1271-1282. DOI: 10.1007/s10096-021-04153-1.
    [11] BEER A, REED RM, BÖLÜKBAS S, et al. Mechanical ventilation after lung transplantation. an international survey of practices and preferences[J]. Ann Am Thorac Soc, 2014, 11(4): 546-553. DOI: 10.1513/AnnalsATS.201312-419OC.
    [12] HADEM J, GOTTLIEB J, SEIFERT D, et al. Prolonged mechanical ventilation after lung transplantation-a single-center study[J]. Am J Transplant, 2016, 16(5): 1579-1587. DOI: 10.1111/ajt.13632.
    [13] HUSAIN-SYED F, FERRARI F, BIRK HW, et al. Pre-transplant renal functional reserve and renal function after lung transplantation[J]. J Heart Lung Transplant, 2020, 39(9): 970-974. DOI: 10.1016/j.healun.2020.05.011.
    [14] WEHBE E, BROCK R, BUDEV M, et al. Short-term and long-term outcomes of acute kidney injury after lung transplantation[J]. J Heart Lung Transplant, 2012, 31(3): 244-251. DOI: 10.1016/j.healun.2011.08.016.
    [15] DORICIC J, GREITE R, VIJAYAN V, et al. Kidney injury after lung transplantation: long-term mortality predicted by post-operative day-7 serum creatinine and few clinical factors[J]. PLoS One, 2022, 17(3): e0265002. DOI: 10.1371/journal.pone.0265002.
    [16] POTESTIO C, JORDAN D, KACHULIS B. Acute postoperative management after lung transplantation[J]. Best Pract Res Clin Anaesthesiol, 2017, 31(2): 273-284. DOI: 10.1016/j.bpa.2017.07.004.
    [17] HOEPER MM, BENZA RL, CORRIS P, et al. Intensive care, right ventricular support and lung transplantation in patients with pulmonary hypertension[J]. Eur Respir J, 2019, 53(1): 1801906. DOI: 10.1183/13993003.01906-2018.
    [18] MALBRAIN MLNG, LANGER T, ANNANE D, et al. Intravenous fluid therapy in the perioperative and critical care setting: executive summary of the International Fluid Academy (IFA)[J]. Ann Intensive Care, 2020, 10(1): 64. DOI: 10.1186/s13613-020-00679-3.
    [19] TRINH BN, BRZEZINSKI M, KUKREJA J. Early postoperative management of lung transplant recipients[J]. Thorac Surg Clin, 2022, 32(2): 185-195. DOI: 10.1016/j.thorsurg.2021.11.006.
    [20] KALAS MA, CHAVEZ L, LEON M, et al. Abnormal liver enzymes: a review for clinicians[J]. World J Hepatol, 2021, 13(11): 1688-1698. DOI: 10.4254/wjh.v13.i11.1688.
    [21] CHAMBERS DC, CHERIKH WS, HARHAY MO, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: thirty-sixth adult lung and heart-lung transplantation report-2019; focus theme: donor and recipient size match[J]. J Heart Lung Transplant, 2019, 38(10): 1042-1055. DOI: 10.1016/j.healun.2019.08.001.
    [22] VAN SLAMBROUCK J, VAN RAEMDONCK D, VOS R, et al. A focused review on primary graft dysfunction after clinical lung transplantation: a multilevel syndrome[J]. Cells, 2022, 11(4): 745. DOI: 10.3390/cells11040745.
    [23] CRINER RN, CLAUSEN E, CANTU E. Primary graft dysfunction[J]. Curr Opin Organ Transplant, 2021, 26(3): 321-327. DOI: 10.1097/MOT.0000000000000876.
    [24] LI D, WEINKAUF J, KAPASI A, et al. Baseline lung allograft dysfunction in primary graft dysfunction survivors after lung transplantation[J]. Respir Med, 2021, 188: 106617. DOI: 10.1016/j.rmed.2021.106617.
    [25] 肖漓, 解立新, 石炳毅. 肺移植免疫学相关基础与临床研究进展[J]. 器官移植, 2021, 12(6): 637-642. DOI: 10.3969/j.issn.1674-7445.2021.06.001.

    XIAO L, XIE LX, SHI BY. Progress on basic and clinical research of immunology in lung transplantation[J]. Organ Transplant, 2021, 12(6): 637-642. DOI: 10.3969/j.issn.1674-7445.2021.06.001.
    [26] BELLIER J, LHOMMET P, BONNETTE P, et al. Extracorporeal membrane oxygenation for grade 3 primary graft dysfunction after lung transplantation: long-term outcomes[J]. Clin Transplant, 2019, 33(3): e13480. DOI: 10.1111/ctr.13480.
    [27] GEUBE M, ANANDAMURTHY B, YARED JP. Perioperative management of the lung graft following lung transplantation[J]. Crit Care Clin, 2019, 35(1): 27-43. DOI: 10.1016/j.ccc.2018.08.007.
    [28] WAJDA-POKRONTKA M, NADZIAKIEWICZ P, KRAUCHUK A, et al. Influence of fluid therapy on kidney function in the early postoperative period after lung transplantation[J]. Transplant Proc, 2022, 54(4): 1115-1119. DOI: 10.1016/j.transproceed.2022.02.021.
    [29] SCHULTZE BS. Fluid management in lung transplant patients[J]. Nurs Clin North Am, 2017, 52(2): 301-308. DOI: 10.1016/j.cnur.2017.01.007.
    [30] NATALINI JG, DIAMOND JM. Primary graft dysfunction[J]. Semin Respir Crit Care Med, 2021, 42(3): 368-379. DOI: 10.1055/s-0041-1728794.
    [31] 李基伟, 徐磊, 韩志军, 等. 肺移植术后原发性移植功能障碍风险因素的Logistic回归分析[J]. 中华医学杂志, 2018, 98(19): 1503-1506. DOI: 10.3760/cma.j.issn.0376-2491.2018.19.010.

    LI JW, XU L, HAN ZJ, et al. Logistic regression analysis of risk factors for primary graft dysfunction after lung transplantation[J]. Natl Med J China, 2018, 98(19): 1503-1506. DOI: 10.3760/cma.j.issn.0376-2491.2018.19.010.
    [32] WANG X, O'BRIEN ME, YU J, et al. Prolonged cold ischemia induces necroptotic cell death in ischemia-reperfusion injury and contributes to primary graft dysfunction after lung transplantation[J]. Am J Respir Cell Mol Biol, 2019, 61(2): 244-256. DOI: 10.1165/rcmb.2018-0207OC.
  • 加载中
图(1) / 表(3)
计量
  • 文章访问数:  210
  • HTML全文浏览量:  113
  • PDF下载量:  81
  • 被引次数: 0
出版历程
  • 收稿日期:  2022-07-17
  • 网络出版日期:  2022-11-14
  • 刊出日期:  2022-11-15

目录

    /

    返回文章
    返回