原位心脏移植手术的体外循环管理

Management of Extracorporeal Circulation on Orthotopic Heart Transplantation

目的总结探讨同种原位心脏移植手术体外循环管理的经验和方法.方法回顾分析2003年4月至今昆明医科大学附属延安医7例终末期心脏病患者的同种原位心脏移植手术.采用浅中低温、轻中度血液稀释、中高流量CPB体外循环,注重供体心肌保护,应用常规超滤与改良超滤技术,行多指标监测和临床观察.结果7例患者体外循环过程平稳,手术过程顺利.例1、例2和例5患者生存至今,已分别存活10 a、9 a和5 a;例3患者术后存活1 a;例4和例6患者死于移植术后右心衰、急性排斥反应;例7患者死于停机困难、严重低心排.结论进行良好的体外循环管理,合理选择供体心脏保护技术,减轻再灌注损伤和积极保护心肺功能是原位心脏移植手术体外循环管理的关键.

Objective To explore an effective method for extracorporeal circulation on orthotopic heart transplantation.Methods Seven patients with end-stage heart disease who need orthotopic heart transplantation operation were retrospective analyzed in our hospital from 2003 April up to now.Shallow low and moderate temperature,mild-to-moderate blood dilution and high flow CBP extracorporeal circulation was used,cardiopulmonary l protection was emphasize,conventional ultrafiltration combined with modified ultrafiltration technology was applicated,and multiple clinical index were monitored and observed.Results Anesthesia process was stable,7 cases were operated successfully.The patients of cases 1,2 and 5 were survived until now（10,9 and 5 years,respectively）.Case 3 was survived for 1 year.Cases 4 and 6 died of right heart failure after transplantation and acute rejection.Case 7 died of shutdown difficulties and severe low cardiac output.Conclusions Rational choice of cardiopulmonary protection method,effective management of extracorporeal circulation,active alleviation of reperfusion injury and protection of the heart-lung function are key factors for successfully extracorporeal circulation management on orthotopic heart transplantation.