【摘要】 目的总结1例左肺移植联合右肺减容积术围术期治疗的体会。方法为1例慢性呼吸衰竭患者施行同种异体左肺移植术+同期右肺减容积术。结果患者术后48 h脱离呼吸机。但于第3天和第4天因左、右侧胸腔先后出现活动性出血而分别行剖胸止血。第6天出现急性排斥反应,激素冲击后缓解。第14天因移植肺细菌感染加重予加强抗感染治疗。第20天并发术后器官精神综合征。第30天移植肺继发真菌感染,经伏立康唑治疗后好转。第60天发现左主支气管吻合口狭窄,行射频消融治疗。结论正确的围术期处理是肺移植患者长期存活的关键,重点是防治移植肺早期失功能和围术期的感染。更多还原

【Abstract】 Objective To summarize the perioperative management of left lung transplantation in combina- tion with right lung volume reduction in one case.Methods Left lung transplantation in combination with right lung volume reduction was performed in a case of end-stage respiratory failure.Results The patient was successfully ex- tubated 48 hours after operation.Postoperative hemothoraxs occured and reoperation in left side of thoracic cavity was performed 3 days later and in right side 4 days later.Acute allograft rejection occurred 6 days later.The patient re- sponded promptly by administering a bolus dose of methylprednisolone.The transplanted lung was susceptible to bac- terial infection 14 days later,then appropriate broad-spectrum antibiotic therapy was administered.The recipient de- veloped the postoperative organic mental syndromes 20 days after surgery.Fungal infection of the transplanted lung occurred 30 days later and was successfully treated by Voriconazole.Bronchoscopic evaluation of the airway found the stenosis of the left main bronchus 60 days later.Treatment of the entity was performed satisfactorily with radiofre- quency ablation.Conclusion Corrective perioperative management plays a major role in the long-term survival of lung transplantation recipient.Prevention of early graft dysfunction and perioperative infection are important in ensu- ring an early successful outcome.更多还原