摘要
目的总结9例犬供心超长时间保存后行原位心脏移植的体外循环管理经验。方法供体心脏以冷UW液（3例）或自制保存液（6例）灌注停跳、摘取心脏后保存24h；在全麻下以标准法或双腔静脉法术式行犬原位心脏植入，体外循环均采用浅低温中流量、中度血液稀释法，以移植心脱离体外循环后，血流动力学稳定（窦性心律、心率≥90次／min、平均动脉压≥90mmHg，1mmHg=0．133kPa）4h为手术成功。结果全组体外循环过程顺利，体外循环总时间（180±30）min，升主动脉阻断时间为（130±20）min，后并行时间（60±10）min，供心热缺血时间0～30s、冷缺血时间（24±0．5）h。主动脉开放后，3例移植心自动复跳，4例移植心电击复跳，移植心复跳受者手术均成功。死亡2例为实验早期手术操作技巧不当所致。结论除良好的供心保护外，良好的体外循环管理亦是犬心脏移植成功的关键。
AIM To summarize the experience of management of cardiopulmonary bypass （ CPB ） for canine orthotopic heart transplantation after long-term graft cold preservation in 9 dogs. METHODS The beating of donor hearts were ceased by in situ perfusion with either 1 000 ml of cold UW solution （3 cases） or self-made solution （6 cases ） through aorta, and the hearts were then removed from donors and preserved at 4℃ for 24 h. Under the combined intravenous-inhalational general anesthesia, canine orthotopic heart transplantation was performed using a method of either standard or bicaval technique with the aid of CPB, which was conducted with mild hypothermia and moderate flow rate perfusion. The transplant surgery was considered to be successful when the recipient＇s hemodynamics was kept well and stable （sinus rhythm, heart rate≥90 bpm, mean artery pressure ≥90 mmHg） for 4 h after withdrawal of the CBP. RESULTS The CPB procedures in all cases went smooth with a total time of （180 ±30） min, the ascending aorta was clamped for （130 ± 20） min, the accessorial circulation time was （60 ± 10） min, the warm ischemic time of grafts ranged from 0 to 30 seconds and the cold ischemic time was （24 ± 0. 5 ） h. In the 9 cases, 3 cardiac grafts resumed sinus rhythm automatically and four grafts resumed beating through electroshock. These 7 cases with reheating cardiac graft survived with stable hemodynamics. Cardiac graft of the other two recipients was unable to resume the beating due to surgical problems in the early period of this experiment. CONCLUSION In addition to cardiac graft preservation and protection, appropriate CBP management is also critical to the successful orthotopic heart transplantation after long-term donor heart preservation in dogs.
出处
《心脏杂志》
CAS
2008年第5期559-562,共4页
Chinese Heart Journal
关键词
犬
供心保存
原位心脏移植
体外循环
dogs
donor heart preservation
orthotopic heart transplantation
cardiopulmonary bypass
