心、肺联合移植一例报告

Perioperative care on one case of heart-lung transplantation

目的对1例心、肺联合移植术进行总结分析。方法对1例患先天性心脏病、室间隔缺损合并艾森曼格综合征者施行同种异体原位心、肺联合移植术,手术在中低温、体外循环下进行。术后对受者进行密切监护,积极防治排斥反应和感染。结果术中体外循环时间240min,升主动脉阻断时间125min;患者术后第7、203d发生移植肺急性排斥反应,第177、228d发生移植心急性排斥反应,均经治疗逆转;第9d发生肺部及胸腔感染,经抗感染治疗痊愈;第265d发生肺部毛霉菌感染,经两性霉素B治疗后症状控制;目前受者的心功能为Ⅰ级,超声心动图提示心脏结构及瓣膜功能基本正常,肺部感染的临床表现基本消失,生活自理。结论良好的心肺保护、细致的外科操作和正确的围手术期处理是心、肺联合移植成功的关键。

Objective To summarize one case of combined heart-lung transplantation. Methods This operation in situ was performed on a patient with Eisenmenger’s syndrome because of ventricular septal defect of congenital heart disease under moderate hypothermia and cardiopulmonary bypass. The recipient was subjected to critical care against infection and rejection after operation. Results The duration of cardiopulmonary bypass was 240 min and aortic clamp was 125 min. On the day 7 and 203 after operation, there were attacks of acute lung rejection. On the day 177 and 288, there were attacks of heart rejection. The pneumonia and thoracic infection on the day 9 caused by Pseudomonas aeruginosa was controlled, and pneumonia on the day 265 caused by Aspergillus was treated by amphotericin B. Until now, his cardiac function was on class Ⅰ with normal results of echocardiogram. He was self-care without clinical manifestation of infection. Conclusion The success of heart-lung transplantation is based on fine organ preservation, careful surgical procedure and proper perioperative treatment.