摘要
目的分析同种异体原位心脏移植治疗终末期心脏病患者的效果。方法回顾性收集郑州大学第一附属医院心血管外科13例同种异体原位心脏移植患者的临床资料,分析供心获取与保护、受者术前评估与维持治疗、感染的预防与治疗、免疫抑制剂的应用、术后并发症的治疗等情况。结果13例心脏移植手术,供心冷缺血时间10~360(200.8±38.0)min,手术时间244~616(345.7±33.4)min,体外循环时间94~205(196.7±22.4)min,主动脉阻断时间35~102(74.4±6.8)min。术后外科重症监护病房住院时间5~91(29.1±7.4)d,围手术期死亡2例,1例死于多器官衰竭,1例死于感染性休克。随访时1例死于移植物衰竭。术后1个月心功能均达到纽约心脏协会(NYHA)心功能分级Ⅰ~Ⅱ级,超声心动图检查左室射血分数为58%~65%[(62.7±5.6)%],术后6个月左室射血分数为58%~66%[(62.4±0.7)%],余存活患者恢复良好。结论心脏移植是治疗终末期心脏病的首选方案。随着心脏移植技术的成熟,围手术期管理的优化,患者生存率提高,生活质量得到改善,临床效果良好。
Objective To analyze the therapeutic effect of allogeneic in situ heart transplantation for patients with end-stage heart disease.Methods The clinical data of 13 patients with allogeneic in situ heart transplantation in the Department of Cardiovascular Surgery of the First Affiliated Hospital of Zhengzhou University were retrospectively collected.The donor heart acquisition and protection,preoperative evaluation and maintenance treatment of the recipient,prevention and treatment of infection,application of immunosuppressants,and treatment of postoperative complications were analyzed.Results Cold ischemia time of the donors heart in 13 heart transplantation cases ranged from 10 to 360(200.8±38.0)min,operative time from 244 to 616(345.7±33.4)min,extracorporeal circulation time from 94 to 205(196.7±22.4)min,and aortic block time from 35 to 102(74.4±6.8)min.Postoperative surgical intensive the length of stay in the intensive care unit ranged from 5 to 91(29.1±7.4)d.There were two perioperative deaths,one dead from multiorgan failure and one dead from infectious shock.One dead from graft failure at follow-up.New York Heart Association(NYHA)cardiac function classification of all the patients were I to H at one month postoperatively,with a left ventricular ejection fraction of 58%to 65%[(62.7±5.6)%]on echocardiography.At six months postoperatively,the left ventricular ejection fraction was 58%to 66%[(62.4±0.7)%],and the remaining surviving patients recovered well.Conclusion Heart transplantation is the preferred option for treating end-stage heart disease.With the maturation of heart transplantation technology and optimization of perioperative management,the survival rate and quality of life of patients are improved,and good clinical results are obtained.
作者
吴志刚
付庆林
罗鸿
马宁
张亮
张俭
樊东凯
张新
WU Zhigang;FU Qinglin;LUO Hong;MA Ning;ZHANG Liang;ZHANG Jian;FAN Dongkai;ZHANG Xin(Department of Cardiovascular Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《河南医学研究》
CAS
2022年第8期1354-1358,共5页
Henan Medical Research
基金
河南省科技攻关计划项目(SBGJ202003049)。
关键词
终末期心脏病
心脏移植
供体获取与保护
围手术期管理
end-stage heart disease
heart transplantation
donor acquisition and protection
perioperative management
