可逆性肺高压在行原位心脏移植术中的危险性分析  

Retrospective study on risk factors of reversible pulmonary hypertension in heart transplantation recipients

作　　者：陈伟[1] 姜桢[1] 

机构地区：[1]复旦大学附属中山医院麻醉科,上海200032

出　　处：《复旦学报（医学版）》2006年第5期635-638,共4页Fudan University Journal of Medical Sciences

基　　金：上海市科委重大项目基金(024119001)资助

摘　　要：目的对心脏原位移植术进行术前评估和危险性因素分析。方法对2000年5月-2005年4月间本院106例预行原位心脏移植的病例作回顾性分析。资料分为术前一般状态及肺血管反应性评估、术前实验室检查与用药、麻醉情况、外科情况、术后随访5部分。将气管导管拔除延迟作为应变量进行单因素和Logistic分析。结果除10例经术前评估进入心肺联合移植等待名单外,在其余96例实施原位心脏移植术的病例中,肺高压组经静脉输注前列腺素E1(PGE1)后,肺血管阻力(PVR)和跨肺压(TPG)有下降(P<0.05),继而吸入NO,PVR下降(26.3±5.6)%(P<0.05),TPG下降(20.5±3.8)%(P<0.05);将气管导管拔除延迟(术后超过24h)作为应变量的单因素分析中发现,肺高压、心肺转流后低血压、肾功能损害、供心缺血时间>4 h和术前EF<30%有统计学意义(P<0.05);将单因素分析后有意义的因素一起放入多元Logistic模型进行逐步回归,肺高压与术前射血分数(EF)<30%进入模型(OR值12.96和3.57)。结论经术前评估和处理,让肺血管达到最大扩张状态,使原本认为不可逆的固定的肺高压显现出可逆的有反应的一面,将给此类患者实施心脏移植带来可能;肺高压、心肺转流后低血压、肾功能损害、供心缺血时间>4 h和术前EF<30%是术后延迟拔管的危险因素。Purpose To get a preoperative evaluation and analysis of the risk factors in heart transplantation recipients. Methods We reviewed the data of 106 patients prepared to receive heart transplantation. These data include ASA classification, lab-test, and procession of anesthesia, surgery and postoperative follow-up. All patients had invasive pulmonary artery monitoring. Unvaried analysis and logistic regression were used to examine the relation between risk factors and later extubation. Results After preoperative evaluation, 96 patients were performed heart transplantation. The PVR and TPG were significantly decreased in PH group after iv PGE1 and inhalation NO（P〈0.05）. PVR decreased （26.3 ± 5.6） % （P〈0.05）, TPG decreased （20.5 ± 3.8） % （P〈0.05） ;in univariate analysis of factors related to later extubation, we found PH, hypotension after CPB, renal dysfunction, ischemia time of donor＇s heart and EF〈30% have statistical significance and put them in multielement logistic model run stepwise regression, PH and EF〈30% ingress the model（OR value 12.96 and 3.57）. Conclusions It is critical for PH patients under HT had a proper preoperative evaluation and preparation; PH, hypotension after CPB, renal dysfunction, ischemia time of donor＇s heart and EF〈30% were risk factors of later extubation.

关 键 词：肺高压 原位心脏移植术 肺血管阻力 

分 类 号：R654[医药卫生—外科学]