缺血时间超过六小时的供心保护以及移植术后近期效果  

Early results in 26 patients with long donor ischemia time in orthotopic heart transplantation

作　　者：洪涛[1] 王春生[1] 宋凯[1] 赖颢[1] 陈昊[1] 杨兆华[1] 

机构地区：[1]复旦大学附属中山医院心脏外科,上海200032

出　　处：《中华器官移植杂志》2007年第9期550-552,共3页Chinese Journal of Organ Transplantation

基　　金：上海市科委重大项目(024119001)

摘　　要：目的探讨缺血时间超过6 h的供心保护以及该类心脏移植的效果。方法因客观原因导致26例供心缺血时间超过6 h,达(401±43)min。切取供心时,快速显露心脏,进行有效的左、右心腔减压,然后从主动脉根部灌注4℃改进的St.Thomas液500 ml,心脏表面用冰生理盐水冲洗降温。取下心脏后,从主动脉根部顺行灌注4℃UW液2000 ml,置于UW液中保存。针对肺动脉压较高者,术中给予硫前列酮,并持续吸入一氧化氮,以降低肺动脉压。26例均行双腔静脉吻合法原位心脏移植术。结果26例全部存活,21例心脏自动复跳,5例电击后复跳。术后1周,超声心动图检查提示26例的心脏各腔室大小均在正常范围,肺动脉压力在正常范围,左室射血分数正常。1例因冠状动脉开口异常导致术后不能停用体外循环,经再手术重新吻合后顺利停止体外循环。1例术后因心功能不全而不能停用呼吸机,并出现肾功能异常,行气管切开及床旁血液透析。2例出现Ⅰ度房室传导阻滞。1例有中等量心包积液,未予处理。结论在贯穿供心切取至移植的良好的心肌保护前提下,适度超过安全保存时间的供心,移植后也能获得满意的近期效果,即便如此,仍应主张供心保存时间应在安全时限内。Objective To introduce the donor heart preservation techniques and study the clinical results in 26 patients undergoing orthotopic heart transplantations with long donor ischemia time （DIT） in our center. Methods From Sept. 2004 to Aug. 2006, 26 patients underwent orthotopic heart transplantation at our center with DIT longer than 360 min. Crystalloid cardioplegia was infused through aortic root after aorta was cross clamped. UW solution was used when donor heart was removed. All patients underwent bicaval anastomotic cardiac transplantation. NO was inhaled through ventilator during and after operation in patients with pulmonary hypertension. Results DIT was 360- 560 （mean 401 ± 43） min. There was no operative death in this group. Echocardiography and X-ray examinations in one month were normal. One case of abnormal coronary orifice was subjected to reanastomosis of aorta. One case of renal failure post-operation was subjected to blood dialysis. Conclusion With proper donor heart procurement and preservation, recipient selection, anastomotic technique, efficient postoperative surveillance and pulmonary hypertension treatment, transplanted patients with long DIT can obtain the satisfactory short-term outcome.

关 键 词：心脏移植 心肌缺血 细胞保护 移植物存活 

分 类 号：R654.2[医药卫生—外科学]