心肺联合移植术后管理和并发症的处理

Heart-lung transplantation: postoperative management and treatment of complications

目的总结两例心肺联合移植术(CHLT)后并发症处理的经验。方法对两例先心病室间隔缺损艾森曼格综合征CHLT管理和术后出现的出血、肺部感染、肺不张、肺或心脏的急性排斥反应等并发症进行综合处理,包括积极输血和纠正凝血紊乱、抗感染、肺不张复张术、免疫冲击治疗以及免疫方案的调整、呼吸机辅助呼吸、营养支持等。结果术后多种并发症已基本控制;两位患者均存活(分别为632天和508天)。结论CHLT后严密监测和及时有效的处理并发症对减少死亡率和改善预后有重要的意义。

Objective To summarize our clinical experience in the management of postoperative and treatment of complications in two cases of combined heart-lung transplantation （CHLT）. Methods The study involved two cases that underwent CHLT in our unit for Eisenmenger＇s syndrome due to ventricular septal defect. Postoperative complications included bleeding, lung infection, atelectasis, attacks of acute lung or heart rejection. Management and treatment of post-transplantation complications relied upon timely blood transfusion, correction of the coagulation profile, implementation of anti-infection measures, lung re-expansion therapy, immunosuppressive stoss therapy, assisted mechanical ventilation, use of anxyolitics, and nutritional support. Results All post-transplantation complications were successfully controlled. Both patients are well and alive 632 days and 508 days after transplantation respectively. Conclusion Close monitoring, timely and effective treatment of complications after transplantation are of great importance in reducing mortality and further improving the prognosis.