原位心脏移植术后血流动力学监测及治疗

Postoperative monitor of hemodynamics of orthotopic heart transplantation and treatment of its disorders

目的探讨原位心脏移植术后血流动力学监护及治疗对提高心脏移植早期存活率的意义。方法41例晚期心脏病患者接受同种异体原位心脏移植,术后密切监护移植心脏的功能,维持患者的血流动力学稳定。结果所有患者术后均接受血管活性药物治疗,移植早期6例患者发生移植心脏急性右心衰竭而死亡,35例患者长期存活,生活质量良好。结论原位心脏移植术后去神经心脏具有特殊的血流动力学特点,围术期密切监护和注意血管活性药物的合理科学应用是减少早期移植物急性功能不全的关键。

Objective To study the postoperative hemodynamics after heart transplantation and treatmernt for disorders due to denervated transplanted hearts in order to improve the short-term outcome of heart transplantation. Methods Forty-one patients with end-stage cardiopathy underwent orthotopic cardiac transplantation. The changes in the graft function were closely monitored during the postoperative period in order to maintain the stability of hemodynamics of the allografts. Results All recipients received vasoactive drug therapy and 6 recipients died of acute dysfunction of the right ventricle of the allograft during the postoperative period. The remaining patients survived well and led a life with rather good quality. Conclusion The hemodynamic characteristics of a denervated grafted heart are unique. Close monitoring and good nursing care with rational administration of vasoactive drugs are the key measures for the prevention of acute dysfunction of the allograft in the early postoperative period.