同种异体原位心脏移植的体外循环管理

Experiences of cardiopulmonary bypass in 9 allograft orthotopic heart transplantation

目的总结同种异体原位心脏移植术体外循环(CPB)的经验。方法采用中度低温、轻度血液稀释和高流量体外循环灌注技术;术中注意心、肺及肾等重要脏器的保护。经主动脉根部一次灌注4℃改良St.Thomas液500 ml使供心快速停搏,供心离体后用4℃威斯康星大学溶液(UW液)1 000 ml灌注,并置于UW液中低温保存。结果 9例患者手术顺利,平稳脱离体外循环机。住院时间为(63.33±33.39)min,供心缺血时间为(401.83±115.97)min,体外循环时间(121.67±49.25)min。4例于主动脉开放后自动复跳,5例电除颤后复跳。出院时左室射血分数为(73.63±6.26)%。结论良好体外循环管理,有效的供心心肌保护及重要脏器保护是同种异体原位心脏移植术成功的关键。

Objective To summarize the cardiopulmonary bypass （CPB） management experiences in 9 cases of allograft orthotopic heart transplantation. Methods The moderate hypothermia, mild hemodilution and moderate to high flow rate perfusion were applied to the recipients. The myocardium,lung, kidney and blood were received special protective strategies for the organ function conservation. The donor hearts were arrested with 500 ml modified St. Thomas solution at 4±C through the root of aorta,then flushed with 1000 ml UW solution at 4 %. The donor heart were preserved in an aseptic plastic bag filled with ice saline, and the ice mud was covered the bag outside. The donor hearts were dripped with 4℃ saline solution into left atrium in the period of anastomosis. Results The inhospitable time was （63.33 ± 33.39） min, CPB time was （ 121.67 ± 49.25 ） min, and the ischemia time was （401.83 ± 115.97 ） min. 4 cases recovered the sinus rhythm automatically,while 5 cases were recovered the sinus rhythm after defibrillation. Left ventrieular ejection fractions were （73.63 ± 6.26） % when discharged from hospital. Conclusion Proper CPB management,the vital organs and donor heart protection is important for ensuring the surgical safety in patients undergoing allograft orthotopie heart transplant.