10例犬心脏移植实验手术技巧体会

The experience of 10 canines experimental orthotopic heart transplantation

目的 通过心脏移植动物实验 ,为掌握手术技术要点 ,向临床工作平稳过渡积累经验。 方法 在全麻体外循环、中度低温下对 10例犬实施了原位心脏移植术。 结果 6例移植心脏自动复跳 ,4例电击除颤恢复窦性心律。心脏复跳停机后短时间内血流动力学均基本平稳 ,术后存活 3小时～ 15小时。死亡原因 :吻合口出血 5例。移植心脏出现心肌肿胀、收缩无力 ,应用血管活性药物难以维持心率、血压致死亡 3例。 2例分别于术后 10小时、15小时后能站立行走 ,被处死。 结论 提高吻合技术 ,重视供体与受体吻合口的匹配 ,避免吻合口出血 ,加强心肌保护、防止心肌肿胀 。

Objective To accumulate experience for conducting heart transplanation in clinic Methods The canine orthotopic heart transplanation was performed in 10 dogs under general anesthesia and moderate hypothermic cardiopulmonary bypass Results Spontaneous recovery of heart beat occurred in 6 dogs and recovery of heart beat by defibilltion in 4 dogs Hemodynamic parameters were relatively stable when the hearts began beating and the cardiopulmonary bypass was over All dogs died from 3 hours to 15 hours after the operations 5 died of bleeding at anastomotic stoma 3 died of difficult keeping heart rate and blood pressure,for the heart swelling and powerless beating,even after much vasoactive medicine was used 2 could walking at 10th and 15th hour after the operations respectively,finally they were killed Conclusion To promote the technique of anatomosis and pay attention to the size of the stoma of donor recipient which must be appropriate for each other,to avoid the bleeding at the anastomotio stoma,strenthen myocardial protection and prevent the myocardial swelling should be important factors to assure the success of heart transplantation