28例心脏移植早期右心功能不全的防治

Prevention and treatment of right graft-heart dysfunction at early stage post transplantation-report of 28 cases

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.