心脏移植围术期的处理

Management of cardiac transplantation during perioperative period

目的：总结心脏移植围手术期的初步经验。方法：3例扩张性心肌患者进行了双腔静脉法的同种原位心脏移植，围手术期间对于受体的维护、供心离体时间长的保护、血流动力学的支持、抗排异反应及感染方面的处理。结果：3例患者均存活，心功能由Ⅳ级提高到Ⅰ-Ⅱ级，未发生排异及感染等并发症，随访结果良好。结论：选择合适的供体和受体、良好的供心保护技术、有效的血流动力学支持、抗排异反应：疗案得当、防止感染是围手术期处理的重要组成部分，是手术成功的关键。

Objective： To sum up the experience of intraopemtive management of orthotopic cardiac thransplantation. Methods：3 recipients suffered from terminal myoeardiosis. The transplantive operation was performed with inferior and superior vena anastomotic technique. During perioperative period, we sdected and maintained the recipients, protected donor isolated heart, supported circulation, decreased immunitive reaction, controlled infections. Results： 3 patients survived and discharged uneventfully, heart function improved from NYHA class Ⅳ preoperatively to NYHA class Ⅰ-Ⅱ. Conclusion： Suitable recipient, proper donor heart procurement and preservation, suitable maintenance of circulation, proper managements of anti-immunitive reaction,prevention of infeetiom are critical for successful heart transplatation.