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28例心脏移植早期右心功能不全的防治 被引量:21

Prevention and treatment of right graft-heart dysfunction at early stage post transplantation-report of 28 cases
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摘要 目的 探讨心脏移植术后早期右心功能不全发生的相关因素及其防治措施。方法 选择 1995年 8月~ 2 0 0 1年 8月施行同种异体原位心脏移植术的 2 8例患者作为观察对象。术前受者测肺周血管阻力 (PVR) ,术后早期监测中心静脉压 (CVP)及右心功能状态。结果  2 8例受者术后早期均出现不同程度的CVP升高 ,其中 6例出现典型右心衰竭表现 (CVP >2 5cmH2 O)。共死亡 6例 ,其中 3例术后早期死于右心衰竭 ,术前PVR均 >5wood单位。其余受者存活时间均已超过 18个月 ,生活质量良好 ,最长存活时间已达 7年半。结论 选择合适的供、受者 ,正确的手术方法 ,良好的供心保护及尽早防治移植心脏右心功能不全 ,是避免或减轻术后早期右心衰竭发生的关键。 ObjectiveTo explore the causes and management of right graft-heart dysfunction at early stage after transplantation.MethodsFrom Aug.1995 to Aug. 2001, 28 patients with endstage dilated cardiomyopathy und erwent orthotopic heat transplantation. Pulmonary vascular resistance (PVR) were measured before transplantation, and central vein pressure (CVP) and right graf t-heart function were monitored by Swan-Ganz catheter and echocardiography at postoperative early stage.ResultsAll of 28 recipients had abnormal higher CVP at postoperative early stage and 6 patients had clinical right graft-heart failure (CVP>25?cm H 2O). Three of 6 d ead cases died of right heart failure after transplantation, whose PVR were more than 5 woods preoperatively. Twenty-two patients survived for 18 months with g ood quality of life.ConclusionAccurate selection for donor and recipient, suitable surgical procedure, excelle nt myocardial preservation, effective protection of recipient's renal function, early prevention and management of right graft-heart dysfunction can significa ntly decline incidence of right heart failure at postoperative early stage.
出处 《中华器官移植杂志》 CAS CSCD 北大核心 2004年第2期80-82,共3页 Chinese Journal of Organ Transplantation
关键词 心脏移植 右心功能不全 术后并发症 危险因素 肺周血管阻力 中心静脉压 Heart transplantation Ventricular dysfun ction,right
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  • 1Srinivas M, Robert LK, Barry FU, et al. Preoperative pulmonary hemodynamics and early mortality after orthotopic cardiac transplantation: the pittsburgh experience. Am Heart J, 1993,126: 896-904.
  • 2Robbins RC, Barlow CW, Oyer PE, et al. Thirty years of cardiac transplantation at Stanford University. J Thorac Cardiovasc Surg,1999,117: 939-951.
  • 3廖崇先,李增棋,陈道中,林潮,廖东山,吴锡阶,翁钦永,林峰,陈良万,郭尚耘,杜剑之,林雁娟.心脏移植治疗晚期扩张型心肌病七例报告[J].中华器官移植杂志,1999,20(2):79-81. 被引量:29
  • 4李增棋,廖崇先,陈道中.二例原位心脏移植失败的经验总结[J].中华器官移植杂志,1998,19(4):237-239. 被引量:6

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