摘要
背景:供心资源匮乏是困扰心脏移植术的世界性难题,拓宽供心纳入标准、合理应用边缘供心,是缓解供心资源匮乏的有效途径,也是目前心脏移植术努力发展的方向。目的:比较常规供心与边缘供心在终末期心脏病患者心脏移植术中的应用效果。方法:收集2018年4月至2021年3月进行心脏移植的80例终末期心脏病患者的临床资料,根据供心来源分为常规供心组56例、边缘供心组24例。所有患者均实施原位心脏移植术,比较两组患者手术相关指标、血清生化及预后指标。结果与结论:①边缘供心组患者手术时间长于常规供心组[(465.35±62.45)min vs.(423.42±58.23)min,t=2.888,P<0.05],术中出血量大于常规供心组[(1235.36±203.4)mL vs.(678.65±123.21)mL,t=15.075,P<0.01];②随访12个月,两组患者血清肌酸激酶同功酶、心肌钙蛋白Ⅰ、总胆红素、谷丙转氨酶以及左心室射血分数比较,差异无显著性意义(t=0.693,1.322,1.514,1.348,1.285,P>0.05);③边缘供心组感染、肾功能不全发生率(17%,29%)高于常规供心组(2%,9%),差异有显著性意义(χ^(2)=6.349,5.397,P<0.05);④结果表明,在严格做好供心保护、围术期管理的前提下,使用边缘供心可达到常规供心心脏移植术的手术效果,但应预防术后感染、肾功能不全等并发症。
BACKGROUND:The lack of donor heart resources is a worldwide problem in heart transplantation.Broadening the inclusion criteria of donor heart and rationally applying marginal donor heart are effective ways to alleviate the lack of donor heart resources,and they are also the development direction of heart transplantation.OBJECTIVE:To compare the effect of conventional donor and marginal donor heart transplantation in patients with end-stage heart disease.METHODS:Eighty patients with end-stage heart disease who underwent heart transplantation from April 2018 to March 2021 were divided into a conventional donor group(56 patients)and a marginal donor group(24 patients).All patients were given orthotopic heart transplantation.Then operative indicators,serum biochemical and prognostic were compared between the two groups.RESULTS AND CONCLUSION:Compared with the conventional donor group,the operation time[(465.35±62.45)min vs.(423.42±58.23)min,t=2.888,P<0.05]was longer and intraoperative blood loss[(1235.36±203.4)mL vs.(678.65±123.21)mL,t=15.075,(P<0.01)]was higher in the marginal donor group.During the follow-up of 12 months,there were no significant differences in serum creatine kinase MB isoenzyme,cardiac troponin I,total bilirubin,alanine aminotransferase and left ventricular ejection fraction between the two groups(t=0.693,1.322,1.514,1.348,1.285,P>0.05).Compared with the conventional donor group(2%,9%),incidence rates of infection and renal insufficiency were also significantly higher in the marginal donor group(17%,29%;x^(2)=6.349,5.397,P<0.05).On the premise of strict heart donor protection and perioperative management,marginal donor transplantation can achieve the surgical effect similar to conventional donor heart transplantation.However,complications such as postoperative infection and renal insufficiency should be prevented.
作者
段正伟
刘云霏
Duan Zhengwei;Liu Yunfei(The 7th People’s Hospital of Zhengzhou,Zhengzhou 450000,Henan Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2022年第26期4211-4215,共5页
Chinese Journal of Tissue Engineering Research
基金
河南省医学科技攻关计划联合共建项目(LHGJ20191120),项目负责人:刘云霏。
关键词
终末期心脏病
心脏移植
边缘供体
常规供体
治疗结果
end-stage heart disease
heart transplantation
marginal donor
conventional donor
therapeutic outcome
