器官移植2025，Vol.16Issue(6)：898-906,9.DOI:10.12464/j.issn.1674-7445.2025125
俯卧位通气联合VV-ECMO治疗肺移植术后重度原发性移植物失功疗效分析
Analysis of the efficacy of prone position ventilation combined with veno-venous extracorporeal membrane oxygenation in the treatment of severe primary graft dysfunction after lung transplantation
摘要
Abstract
Objective To explore the application effect of prone position ventilation combined with veno-venous extracorporeal membrane oxygenation(VV-ECMO)in the treatment of severe primary graft dysfunction(PGD)after lung transplantation.Methods The clinical data of 75 lung transplant recipients who developed severe PGD after lung transplantation and were treated with VV-ECMO from January 2021 to June 2024 at Wuxi People's Hospital Affiliated to Nanjing Medical University were collected.The patients with severe graft dysfunction after lung transplantation were divided into VV-ECMO group(control group,45 cases)and prone position ventilation combined with VV-ECMO group(treatment group,30 cases).The general data of the two groups of patients were compared,including the donors'clinical data(age,gender and oxygenation index,etc)and the recipients'clinical data[gender,age and body mass index(BMI),etc].Cox regression analysis was used to analyze the influencing factors of the recipients'30-day,90-day and 180-day survival after surgery.The survival curves of the two groups of recipients were drawn using Kaplan-Meier method and compared using the log-rank test.Results The intensive care unit(ICU)stay time,ECMO application time and ventilator use time of control group were longer than those of treatment group.The proportion of male recipients and the BMI of control group were lower than those of treatment group.The 30-day,90-day and 180-day survival of control group was worse than that of treatment group,and the differences were statistically significant(all P<0.05).The univariate Cox regression analysis of the recipients'30-day survival after surgery showed that the recipients'BMI,history of diabetes,enlargement of the right atrium and right ventricle,intraoperative blood transfusion volume and intraoperative red blood cell transfusion volume were statistically significant(all P<0.05).The multivariate Cox regression analysis showed that the history of diabetes and enlargement of the right atrium and right ventricle were risk factors affecting the 30-day survival of lung transplant recipients(all P<0.05).The univariate Cox regression analysis of the recipients'90-day survival after surgery showed that the recipients'BMI,history of diabetes,enlargement of the right atrium and right ventricle,intraoperative blood transfusion volume,intraoperative red blood cell transfusion volume and group variable were statistically significant(all P<0.05).The multivariate Cox regression analysis showed that the history of diabetes,enlargement of the right atrium and right ventricle and group variable were risk factors affecting the 90-day survival of lung transplant recipients(all P<0.05).The univariate Cox regression analysis of the recipients'180-day survival after surgery showed that the recipients'BMI,history of diabetes,right atrium and right ventricle enlargement,intraoperative blood transfusion volume,intraoperative red blood cell transfusion volume and group variable were statistically significant(all P<0.05).The multivariate Cox regression analysis showed that the history of diabetes,enlargement of the right atrium and right ventricle and group variable were risk factors affecting the 180-day survival of lung transplant recipients(all P<0.05).The 30-day,90-day and 180-day survival rates of control group were lower,and the differences between the two groups were statistically significant(all P<0.05),with a median survival time of 100 days in control group.Conclusions In the clinical treatment of severe PGD after lung transplantation,prone position ventilation combined with VV-ECMO may shorten ECMO application time,invasive ventilation time and ICU stay time,and improve the short-term prognosis of lung transplantation.关键词
俯卧位通气/静脉-静脉体外膜肺氧合/肺移植/重度移植物失功/重症监护室/急性呼吸窘迫综合征/氧合指数/有创机械通气Key words
Prone position ventilation/Veno-venous extracorporeal membrane oxygenation/Lung transplantation/Severe primary graft dysfunction/Intensive care unit/Acute respiratory distress syndrome/Oxygenation index/Invasive mechanical ventilation分类
临床医学引用本文复制引用
王大鹏,梁城龙,朱劲松,周涛,徐忠平,胡春晓,许红阳..俯卧位通气联合VV-ECMO治疗肺移植术后重度原发性移植物失功疗效分析[J].器官移植,2025,16(6):898-906,9.基金项目
江苏省科技计划专项基金(BF2022697) （BF2022697）
无锡市卫健委面上项目(M202435) （M202435）
南京医科大学无锡医学中心2024年专病队列(WMCC202401) （WMCC202401）
