脑死亡器官捐献心脏移植供体保护性治疗与功能评价

Protective treatment and functional evaluation of heart transplantation donator with brain death

目的对单中心脑死亡器官捐献供体选择管理及心脏移植手术效果进行总结。方法2014年1月-2016年6月单中心110例终末期心衰患者接受脑死亡器官捐献原位心脏移植手术治疗。其中男性86例,女性24例;平均年龄为（34.5±12.7）岁,体重为（52.7±14.9）kg。其原发病中84例为扩张型心肌病,4例为终末期瓣膜性心肌病,22例为终末期缺血性心肌病。患者的纽约心脏协会（NYHA）心功能分级均为Ⅲ~Ⅳ级。术前超声心动图检查提示：左心室舒张末期内径为（72±9）mm,左心室射血分数为12%~35%,肺动脉压为30~78mm Hg（1mm Hg=0.133k Pa）,全肺阻力均小于48k Pa·s/L。供者年龄为21~45岁,既往无心血管疾病或其他重大脏器病史。供心缺血时间为（165±18）分钟。手术主动脉阻断时间为（72±18）分钟。术后采用环孢素A（Cs A）、吗替麦考酚酯（MMF）和甲泼尼龙进行免疫抑制治疗。结果术后并发症包括右心衰竭9例,肾功能异常13例及急性排斥反应6例。术后围术期死亡8例,其中3例死于低心排出量综合征,2例死于重症感染,3例死于多器官功能衰竭。结论脑死亡捐献供体由于特殊的神经和内分泌等系统发生严重改变,合适供体的选择与管理是心脏移植成功的关键。

Objective To conclude the selection and management of brain death organ donor and the effect of cardiac transplantation on single central. Methods 110 cases heart failure patients received orthotopic heart transplantation from single central between January 2014 and June 2016. There were 86 male patients and 24 female patients. The average age was（34.5±12.7） years old, the average body mass was（52.7±14.9）kg. There were 84 cases diagnosed as dilated cardiomyopathy,4 cases as serious valve disease,22 case of serious ischemic cardiomyopathy. The heart function of all patients was grade NYHA Ⅲ or Ⅳ. The preoperative echocardiography showed left ventricular end-diastolediameter was（72±9） mm, the left ventricular ejection fraction was 12%-35%,the artery pulmonary pressure was 30-78 mm Hg（1 mm Hg = 0.133 k Pa）, total pulmonary resist pressure was less than 48 k Pa·s/L. The donors age were 21-45 years old without any cardiovascular disease or other diseases history of other major organs. The ischemic time of the donor hearts were（165±18）mins. The mean aortic clamp time was（72±18）mins. Cyclosporine A, MMF and prednisone were used as anti-immune response strategy. Results Postoperative complications included 9 cases of right heart failure, 13 renal dysfunctionand 6 cases acute immune rejection. Totally 8 patients died in the perioperative period, in which 3 cases of heart dysfunction,2 case of serious infection and 3 cases of multiple organ failure. Conclusion The restrict brain death donors selection and management is the key point of success of heart transplantation, due to the serious changes in the nervous system and endocrine system of brain death donor.