心脏移植供心的保护  

Preservation of donor heart for orthotopic heart transplantation

作　　者：黄小蝶[1] 叶晓青[1] 

机构地区：[1]广东深圳市孙逸仙心血管医院麻醉科,518001

出　　处：《中国基层医药》2004年第8期924-925,共2页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的　总结同种异体心脏移植供心保护经验。方法　 4例终末期扩张性心脏病心脏移植手术。供心缺血期间采用 4℃改良St .Thomas液顺行灌注快速心脏停搏 ,供心取出后冷生理盐水冲洗心腔 ,继之用4℃UW液 (universityofwisconsinsolution) 10 0 0ml经升主动脉根部单次灌注 ,然后 4℃生理盐水浸泡保存 ,供心运输、移植过程不再行心肌保护液灌注。供心热缺血时间 1～ 3min ,冷缺血时间 110～ 180min(平均 14 2 5± 2 9 0min)。结果　心脏移植完毕开放升主动脉后 4例心脏全部自动复跳 ,辅助循环 34～ 5 4min(平均 4 2 8± 9 8min)。术后心功能恢复良好 ,未出现低心输出量综合征 ,术后 1个月左心室射血分数 (LVEF)恢复到6 0 %～ 6 5 %。 3例存活至今 ,1例术后 5个月因自行停用抗免疫药死于急性排异反应。结论　冷晶体停跳液灌注心脏快速停跳 ,继之 4℃UW液单次灌注结合 4℃生理盐水浸泡保存供心 ,方法简便 ,效果良好 ,供心冷缺血时间可达 3h。Objective To summarize the experience of donor heart preservation in heart transplantation.Methods 4 patients with dilated cardiomyopathy underwent orthotopic heart transplantation at our hospital.In order to preserve the donor heart,we adopted cold crystalloid cardioplegia,then perfused with 4℃ university of wisconsin solution 1000ml only once combined hypothermic storage.The warm ischemic time of donor hearts was one to three minutes.The cold ischemic time of donor hearts was 142.5±29.0 minutes,ranging from 110～180 minutes.Results In all cases heartbeat returned spontaneously after aortic cross-clamping release.The cardiac function of the donors recovered smoothly without low cardiac output syndrome occurred after operation.The left ejection fraction(LVEF) was 60%～65% in 4 cases 1 month after transplantation.3 patients survive,one patient died from acute rejection reaction becanse of interrupted immunosuppression treatment five months postoperatively.Conclusion Donor heart is perfused with 4℃ university of wisconsin solution only once combined hypothermic storage after cold crystalloid cardioplegia,which can provide effective myocardial protection;the cold ischemic time of donor hearts can keep longer than 3 hours.

关 键 词：心脏移植 供心保护 心肌保护 终末期扩张性心脏病 急性排异反应 

分 类 号：R654.2[医药卫生—外科学]