Abstract:

Objective To investigate the predictive value of arterial alveolar oxygen partial pressure ratio in prolonged mechanical ventilation （PMV） after lung transplantation and to construct a predictive model. Methods Aretrospective analysis was conducted on the clinical data of 152 patients who underwent their first lung transplant and received intravenous venous extracorporeal membrane oxygenation support surgery at the Affiliated Wuxi People's Hospitalof Nanjing Medical University from January 2022 to December 2022. According to the duration of invasive mechanical ventilation after operation， all recipients were divided into the PMV group （ventilation duration ＞ 48 h，n ＝ 91） and control group （ventilation duration ≤ 48 h，n ＝ 61）. Perioperative indexes were compared between two groups，includingintraoperative indexes（operation time ， operation methods and cold ischemia time of donor lung）and postoperative indexes〔Hb， PaCO2， HCO3 - ， lactate， P（A-a）O2，P（a/A）O2，and PaO2/FiO2at 0，8，24 h and 48 h after operation， mechanical ventilation time and intensive care unit（ICU） hospitalization time〕. Receiver operating characteristic（ROC） curve，Pearson correlation analysis and multivariate logistic regression analysis were used to analyze the outcomevariables. Results ① There was a significant positive correlation between P（a/A）O2and PaO2/FiO2 （P ＜ 0.001）. ② P（a/A）O2at 8 h after ICU had a good predictive ability for PMV after lung transplantation（sensitivity and specificity were 0.750 and 0.700，AUC was 0.77）. ③ PaO2/FiO2immediately after ICU admission， PaCO2at 8 h after ICU admission，actual HCO3 - ，lactate and P （a/A） O2were independent risk factors for PMV after lung transplantation. Conclusion P （a/A） O2is an independent risk factor for PMV after lung transplantation， and the dynamic changes of P （a/A） O2 should not be ignored. Continuous monitoring of P （a/A） O2is helpful to guide clinical evaluation of prolonged mechanicalventilation after lung transplantation. 

Key words:

Lung transplantation,  , Arterial alveolar oxygen partial pressure ratio,  , Mechanical ventilation

摘要：

目的 探讨动脉肺泡氧分压比〔arterial-alveolar oxygen partial pressure ratio， P（a/A）O2〕对肺移植术后延迟脱机（prolonged mechanical ventilation，PMV）的预测价值并构建预测模型。方法 回顾性分析在南京医科大学附属无锡人民医院 2022 年 1 月至 2022 年 12 月间 152 例首次行肺移植并接受静脉 - 静脉体外膜肺氧合支持手术患者的临床资料。根据术后有创机械通气时间分为机械通气延长 PMV 组（通气时间＞ 48 h，91 例）和对照组（通气时间≤ 48 h，61 例）。比较患者术中指标（手术方式、手术时间和供肺冷缺血时间），入重症监护病房（intensive care unit，ICU）即刻、8 h、24 h、48 h 的动脉血气分析结果 , 记录血红蛋白（hemoglobin，Hb）、二氧化碳分压（partial pressure of carbon dioxide，PaCO2）、实际碳酸氢根 HCO3 - 、乳酸（lacticacid，Lac）、肺泡 - 动脉氧分压差〔difference of alveoli-arterial oxygen pressure，P（A-a）O2）、 P（a/A）O2、氧合指数（oxygenation index，OI ＝ PaO2/FiO2）〕、机械通气时间和 ICU 住院时间。采用受试者工作特征（receiveroperating characteristic，ROC）曲线、Pearson 相关性分析和多因素 Logistic 层次回归分析对结果变量进行分析。结果 ① P（a/A）O2 与氧合指数两者之间呈明显正相关关系（P ＜ 0.001）。② 入 ICU 8 h 后的 P（a/A）O2 对肺移植术后 PMV 具有良好的预测性能（敏感性、特异性分别为 0.75、0.7，AUC 为 0.77）。③ 入 ICU 即刻氧合指数、入 ICU 8 h 后 PaCO2、HCO3 -，Lac，P（a/A）O2 是肺移植术后 PMV 独立危险因素。结论 入 ICU 8 h P（a/A）O2 是肺移植术后机械通气时间延长的独立危险因素，不应忽视 P（a/A）O2 的动态变化，持续监测P（a/A）O2 有助于指导临床评估肺移植术后机械通气延长。

关键词:

肺移植 , 动脉肺泡氧分压比 , 机械通气