改善的心脏移植术前准备方法对已停跳供心心肌的保护作用

Effect of Improvement of Heart Pretransplantation on Myocardial Protection of Non-beating Heart Allograft

目的探讨已停跳供心的原位心脏移植术前准备对已停跳供心心肌保护的作用。方法用已停跳供心为47例终末期心脏病患者实施了原位心脏移植,术前进行充分的准备。心肌保护液均使用HTK液,灌注总量按供体体质量计算,为30～50mL/kg。首先采用8℃的HTK液1000mL直接灌注心脏,供心切下后,放到套有无菌塑料袋的无菌器皿中,再将剩余量的4℃的HTK液灌完,流出的HTK液可用来浸泡供心。结果所有已停跳供心均在移入后恢复泵功能,移植后未发生与心功能相关性并发症。结论充分的术前准备及良好的心肌保护是已停跳供心的原位心脏移植获得成功的关键。

Objective To study effect of improvement of heart pretransplantation on myocardial protection of non-beating heart allograft. Methods From August 2004 to August 2008, non-beating heart allografts were implanted in forty-seven patients with end-stage heart disease. Sufficient pretransplantion were applied in all patients in order to shorten warm isehemic time of non-beating heart allografts and ensure functional recovery of allografts after implanted. HTK solution were employed as myocardial preservation and total perfusion volume was used by 30-50 mL per kilogram of body weight. 1 000 mL of 8 ℃ HTK was first direct prefused during donor harvest, then donor heart was soaked in 4 ℃ HTK solution. Results Forty-seven heart allografts were successfully recovery pump function after implanted. No complication associated with heart function were occur in all recipients. Conclusion Adequate transplant preparation and proper heart preservation are the key of successful application of non-beating heart allografts in clinical heart translantaton.