单肺移植治疗艾森曼格综合征的围手术期处理(附一例报告)

Sing-lung transplant with atrial septal defect repair for Eisenmenger′s syndrome(with one case report)

目的探讨同种异体单肺移植同时行先天性心脏病心内畸形矫正术治疗艾森曼格综合征的围手术期处理要点。方法先天性心脏病房间隔缺损合并艾森曼格综合征患者,在全麻体外循环下行同种异体单肺移植,同时行房间隔缺损修补术。术后严格无菌隔离、呼吸机辅助呼吸、漂浮导管监测肺动脉压、抗感染、三联免疫抑制剂抗排斥等围手术期处理。结果移植肺通气后颜色红润,通气指标正常。术后血流动力学稳定,血气指标在正常范围,心肺功能均有明显改善。术后第11天出现全身性感染于第12天死亡。结论同种异体单肺移植同时行先天性心脏病心内畸形矫正术治疗艾森曼格综合征是可行的;抗感染是围手术期处理的关键。

Objective We report a case with Eisenmenger＇s syndrome who underwent right single-lung ransplantation with closure of atrial septal defect. Methods and Results The candidate was a 52 year old suffered from Eisenmenger＇s syndrome for more than 8 years and experienced an advancing exacerbation during the last 6 years. The operation was perfomed on Dec . 27,2004. The patient was extubated on postoperative day 9,died on postoperative day 12.The causes of death was sepsis and bronchiolitis syndrome. The reversibility of right ventricle dysfunction, lung dysfunction and pulmonary artery pressure after single-lung transplantation in the patient had been improved. The super acute rejection occurred at 12h postperation. The hypohepatia and acute renal failure occurred at 5 day. Conclusion Our preliminary experience shows that concomitant isolated at lung transplantation with cardiac repair could be a viable therapeutic option for patient with Eisenmenger＇s syndrome and normal left ventricular fuction. Anti-infection and anti-rejection were the key points after operation.