DECREASED INCIDENCE OF BRONCHIAL COMPLICATIONS FOLLOWING LUNG TRANSPLANTATION

被引：38

作者：

SCHAFERS, HJ

HAVERICH, A

WAGNER, TOF

WAHLERS, T

ALKEN, A

BORST, HG

机构：

[1] Division of Thoracic and Cardiovascular Surgery, Surgical Center, Hannover Medical School, Hannover

[2] Division of Pneumology, Medical Center, Hannover Medical School, Hannover

[3] Department of Anesthesia, Hannover Medical School, Hannover

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1992年 / 6卷 / 04期

关键词：

LUNG TRANSPLANTATION; BRONCHIAL COMPLICATIONS; CORTICOSTEROIDS; PROSTACYCLINE;

D O I：

10.1016/1010-7940(92)90213-H

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Despite omental wrap and avoidance of prophylactic administration of corticosteroids in the early postoperative phase, ischemic bronchial complications still represent an important source of early morbidity and mortality following lung transplantation. In a retrospective analysis, the effect of pharmacological enhancement of pulmonary collateral flow on bronchial healing was investigated. Thirty-nine consecutive unilateral or bilateral transplant procedures (Tx) were analyzed. Immunosuppression consisted of rabbit antithymocyte globulin (RATG), cyclosporine A, and azathioprine. In group 1 (10 Tx, 12 anastomoses) routine immunosuppression was employed and the anastomoses wrapped with an omental or pericardial pedicle. In group 2 (29 Tx, 41 anastomoses) PGI2 (4 ng/kg per min x 48 h), heparin (200 U/kg per day), and prednisolone (0,5 mg/kg per day) were added to the therapeutic regimen. The 2 groups were comparable with respect to age and sex of the patients, primary diagnosis, type of transplant, intraoperative use of extracorporeal circulation, graft ischemia, duration of mechanical ventilation, and mortality. Bronchoscopic evidence of a significant bronchial ischemia (extending more than 1 cartilagenous ring beyond the anastomosis) was seen in 8 of 12 anastomoses in group 1 vs 14 of 53 anastomoses in group 2 (P = NS). In group 1, significant bronchial stenosis required implantation of an endobronchial silicone stent in 6 of 12 anastomoses, whereas in group 2, no significant bronchial stenosis occurred (P < 0.01). No negative effects possibly related to the prophylactic administration of corticosteroids could be observed. It is concluded that the combined administration of prostacycline, heparin and corticosteroids results in a decreased incidence of ischemic bronchial complications following lung transplantation, possibly due to improved preservation of the bronchial and pulmonary microcirculation and consequently enhanced bronchopulmonary collateral flow.

引用

页码：174 / 179

页数：6

共 31 条

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