原位心脏移植术的围术期临床经验及效果

Experience of Peri-operative management in orthotopic heart transplantation

目的总结心脏移植围术期的心肌保护方法和经验。方法2003年3月至2005年11月为11例终末期心脏病患者实施了原位心脏移植,其中心-肺联合移植、心-肾联合移植各1例。采取标准法1例,双腔静脉法10例。结果全组热缺血时间8￣12min,冷缺血时间90￣292min,术中心肌自动复跳10例,1例电除颤复跳。术后1周超声心动图示各心腔大小、EF值均在正常范围。死亡3例:心-肺联合移植术后气管吻合口瘘合并重度感染1例,心-肾联合移植、单纯心脏移植术后急性肾功能衰竭各1例。随访1￣29个月,8例存活患者心功能均恢复至Ⅰ￣Ⅱ级。结论心脏移植术中除在供心的正确切取过程中注意供心的心肌保护外,还应在术中吻合、术后管理过程的整个围手术期都要重点加强心肌保护,这些均是手术成功的重要基础。

Objective To investigate the proper methods and summarize the experience in protection of donor myocardium from ischemic in orthotopic heart transplantation. Methods From March 2003 to November 2005, orthotopic heart transplantation was performed in 10 patients with end-stage dilated eardiomyopathy and 1 patient with hypertrophic eardiomyopathy. Among them one heart-lung transplantation and one heart-kidney transplantation were included. Conventional standard cardiac transplantation procedure was applied in one patient and bicaval anastomostic cardiac transplantation procedure in the other ten. We evaluate the time of hot and cool ischemia with donor heart and the recovery of postoperative heart function in all 11 patients who underwent heart transplantation. Results Ten donor heart resuscitate automatically after aortic cross clamping released. One case required defibrilating therapy with a dose of 20 J. Postoperative heart function were normal in one week. Two cases died of renal failure and one case died of trachea fistula. The survived patients were recovered well with cardiac function of NYHA Ⅰ-Ⅱ and there was no heart failure in 1-29 month＇s follow-up. Condusion The correct methods of donor heart harvest and intra and postoperative myoeardium protection are very important for successful heart transplantation.