高风险原位同种异体心脏移植术后支气管狭窄的急诊支架置入治疗:1例报告(英文)  

Emergency treatment of endobronchial stent placement for serious main bronchial stenosis following high-risk orthotopic heart allotransplantation: One case report

作　　者：赵永祥[1] 赵玲玲[1] 单忠贵[2] 唐琪[1] 阳玲[1] 范钦明[2] 易波[1] 廖崇先[2] 周志明[1] 欧阳文[1] 朱岳[3] 

机构地区：[1]中南大学湘雅三医院-卫生部移植医学工程技术研究中心,湖南省长沙市410013 [2]厦门大学附属中山医院心脏外科,福建省厦门市361003 [3]美国匹兹堡大学器官移植研究所

出　　处：《中国组织工程研究与临床康复》2007年第25期5011-5015,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：中南大学重点学科建设基金资助项目(2004-24)~~

摘　　要：背景:心脏移植术后支气管软化导致狭窄引起的呼吸功能障碍是一种临床急重症,严重危及移植心脏的功能,高风险多并症心脏移植并支气管支架置入术有待临床观察。目的:报告极高风险原位心脏移植术后因左主支气管软化狭窄塌陷急诊支架置入1例。设计:病例分析。单位:中南大学湘雅三医院-卫生部移植医学工程技术研究中心,厦门大学附属中山医院心脏外科。对象:选择于2005-04在厦门大学附属中山医院心脏外科施行同种异体原位心脏移植术的渐进性扩张型心肌病合并中-重度肺动脉高压患者,女,18岁,渐进性扩张型心肌病病史15年,中-重度肺动脉高压:肺动脉平均压50～51mmHg,同时伴有左主支气管软化塌陷狭窄、混合性(中枢性为主)呼吸睡眠暂停综合征、左下肺不张、右侧肺气肿、类风湿性关节炎等合并症半年。方法:患者心脏移植术后,支气管炎症充血水肿加重了气管软化塌陷狭窄程度,管腔狭窄至4/5,导致阻塞性通气障碍,并发室上性心动过速、室性早搏,移植心脏舒张功能减退(E峰<A峰、移植心脏射血分数降低至EF40%、室壁运动不协调)。予以强心治疗、呼吸机辅助通气,但患者左主支气管狭窄未解除,病情持续恶化。为促使移植心脏功能恢复,解除支气管软化塌陷所致狭窄,纠正阻塞性通气障碍,于心脏移植术后第6天行紧急支气管支架置入治疗。①患者取平卧位清醒状态,在心电监护及经皮血氧饱和度监测下,通过D20光导纤维支气管镜,使用记忆合金网状支架(直径12mm长20mm)解除左主支气管狭窄。常规纤维支气管镜检查,观察支气管狭窄近端,并在电视透视下放置近端定位标志,经狭窄孔探测远端通畅程度,并放置远端定位标志,通过纤维支气管镜工作道内插入引导钢丝,钢丝越过狭窄部位,将镍钛支架装入专用置入器内,顺导丝引入支气管支架植入器,到位良好后BACKGROUND： Ventilation dysfunction caused by bronchomalacia induced bronchostenosis following high-risk heart transplantation is an acute clinical disease, which seriously impairs the function of transplant heart. The case of emergency bronchial stent placement following heart transplantation with high-risk multi-complication has not been reported yet. OBJECTIVE： To investigate the curative effect of emergency stent placement for worse left main bronchial malacia stenosis and collapse following orthotopic heart allotransplantation. DESIGN ： A case analysis SEHINGS： National Ministry of Health Transplantation Engineering and Technical Research Center, the Third Xiangya Hospital, Central South University; Department of Cardiosurgery, Zhongshan Hospital affiliated to Xiamen University. PARTICIPANTS： An 18-year-old female patient with dilated cardiomyopathy accompanied by moderate to severe pulmonary artery hypertension, who sequentially carried out orthotopic heart allotransplantation, was selected from the Department of Cardiosurgery, Zhongshan Hospital affiliated to Xiamen University in April, 2004. She had suffered from dilated cardiomyopathy for 15 years, and the mean pulmonary artery pressure （MPAP） was 50-51 mm Hg, she was also accompanied by left main bronchial malacia, stenosis and collapse, mixed （mainly central-） sleep apnea syndrome, left inferior pulmonary sequestration, right emphysema, and rheumatoid arthritis for half a year. METHODS： After heart transplantation, bronchus inflammation, congested edema aggravated the severity of bronchial malacia, stenosis and collapse, tenosis reduced to 4/5, and led to obstructive type of ventilation, and the patient was also accompanied by supraventricular tachycardia, ventricular extrasystole, and hypofunction of transplant cardiac systolic function （peak E 〈 peak A, .ejection fraction reduced to 40%, inharmonious motion of ventricular wall）. Attempted with inotropic agents and ventilatory support were not relieved, which resulted

关 键 词：原位心脏移植 支气管狭窄 支架置入 

分 类 号：R617[医药卫生—外科学]