术内治疗性血交换对肺移植出血的影响
Sahar A Saddoughi1, Tereza Martinu2, Christopher Patriquin3
1Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
概括
肺移植的手术内治疗性血交换 (iTPE) 可能会增加手术前出血,但它不会对关键的移植后结果产生负面影响,如血胸病或死亡率. 这一发现支持其用于敏感候选人的使用.
科学领域:
- 移植免疫学 移植免疫学
- 心胸外科手术是一项心胸手术.
- 关键护理医学 关键护理医学
背景情况:
- 肺移植候选人通常具有对捐赠者抗原的抗体,需要消毒协议.
- 术内治疗性血交换 (iTPE) 用于减轻交叉匹配阳性肺移植中的免疫风险.
- 对外术期间出血的担忧限制了iTPE在肺移植中的广泛采用.
研究的目的:
- 量化iTPE对肺移植中术后出血的影响.
- 评估iTPE和输血要求之间的关联.
- 评估iTPE对血胸发病率和移植后30天死亡率的影响.
主要方法:
- 追溯队列研究,将接受iTPE的肺移植接受者与没有接受iTPE的接受者进行比较.
- 多变量逻辑回归分析iTPE与大体积输血 (≥5个PRBC单位/24小时) 之间的关联.
- 奇平方测试用于比较群体间的血胸发病率和30天死亡率.
主要成果:
- 16%的患者接受了iTPE (n=142),而84%的人没有 (n=755).
- iTPE与大量外科手术期间输血的几率增加有关 (OR 1.9; 95% CI: 1.2-2.9).
- 血胸发病率 (两组均为5%) 或30天死亡率 (3.5%对2.1%) 没有显著差异.
结论:
- 肺移植中的iTPE可能与术后出血增加有关.
- 使用iTPE增加的出血风险似乎不会影响移植后的关键结果.
- 这些发现表明,iTPE可以安全地用于精选的肺移植接受者.
关键词:
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