心脏移植围手术期处理(附8例临床分析)

Perioperative management of cardiac transplantation

目的总结心脏移植的围手术期处理体会。方法我院自2003年5月至2004年12月共施行了8例原位心脏移植手术。围手术期管理包括术前供受体准备,术后抗排异药物应用、防治感染、循环呼吸维持等。结果1例死于多系统器官衰竭(MSOF),7例存活,其中并发急性排斥反应、右下肺炎、右心功能不全各1例,相应治疗后治愈。心功能Ⅰ～Ⅱ级。随访精神及心理状态良好。结论心脏移植是治疗终末期心脏病最有效的方法。手术成功的关键是选择好合适的受体,使用抗排异药物和注意监测排异反应,有效防治感染和右心衰。

Objective To summarize the experience of perioperative management of cardiac transplantation. Methods From May 2003 to December 2004, 8 patients with advanced heart disease received cardiac transplantation. Perioperative managements include recipient and donor preparation, use of immunosuppressants, anti-infection, circulatory and respiratory support, etc. Results All patients survived with complications of acute rejection in I case, right heart dysfunction in I case, low right pneumonia in I case, except I case died from MSOF （multiple system organ failure）.All recovered well at their discharge ,the heart function is Ⅰ-Ⅱ（NYHA）.Conclusion Cardiac transplantation is an effective method to cure advanced heart disease. Donor selection, use of adequate immunosuppressants and prevention of infection and right heart failure are key points to the success of cardiac transplantation.