肺动脉高压对同种原位心脏移植患者移植后早期血流动力学的影响  

Impact of pulmonary hypertension on early hemodynamics after orthotopic heart transplantation

作　　者：刘明政[1] 王剑辉[1] 杜娟[1] 黄洁[1] 李立环[1] 

机构地区：[1]中国协和医科大学中国医学科学院阜外心血管病医院麻醉科,北京100037

出　　处：《中华医学杂志》2007年第37期2618-2622,共5页National Medical Journal of China

摘　　要：目的分析研究心脏移植患者术前不同程度的肺动脉高压对患者移植后早期血流动力学指标、超声心功能检查、围术期并发症和死亡率的影响。方法回顾总结2004年6月至2006年12月,阜外心血管病医院连续做的67例同种原位心脏移植手术患者。根据术前肺血管阻力将患者分为3组:Ⅰ组无肺动脉高压、肺血管阻力等于或低于2.5 Wood 单位15例;Ⅱ组轻到中度肺动脉高压、肺血管阻力大于2.5 Wood 小于5.0 Wood 单位42例;Ⅲ组严重的肺动脉高压、肺血管阻力等于或大于5.0 Wood 单位10例。连续监测并记录麻醉前、术后即刻、12、24及48h 的 CVP、MPAP、CO、SvO_2、PAWP 等指标;停体外循环后、术后第1、3、7d、1个月、3个月经超声测定左室舒张末径(LVEDD)、左室射血分数(EF)及二、三尖瓣的返流情况等;术后详细记录各种并发症、治疗情况及术后30d 的死亡率。结果本研究患者均完成心脏移植手术,3组患者无手术死亡(术后30d 内)。Ⅲ组患者的术前 EF 值与Ⅰ组比较,P<0.05;3组患者的体外循环阻断时间、供体心脏热缺血、冷缺血时间无明显差别;Ⅲ组患者的体外循环时间明显长于Ⅰ组、Ⅱ组 P<0.05,术后带管时间Ⅲ组与Ⅰ组比较,P<0.05。3组间麻醉前 MPAP、PVR,P<0.05,Ⅲ组患者麻醉前 CI 明显低于Ⅰ组、PCWP 明显高于Ⅰ组 P<0.05;Ⅲ组术后各时间点 MPAP、PVR 明显低于麻醉前、特别是术后48h,P<0.05,但仍表现为肺动脉压升高。术后并发急性肾功能衰竭3例(Ⅱ组1例、Ⅲ组2例)、急性右心衰竭6例(Ⅰ组1例、Ⅱ组2例、Ⅲ组3例)。超声检查除Ⅲ组2例患者术后早期显示三尖瓣中量返流外,未发现明显的心脏扩大、收缩功能降低等异常情况。结论术前严重肺动脉高压患者心脏移植后早期肺动脉压力明显降低,但术后易发生急性右心衰竭等并发症,经积极的强心、利尿等治疗措施恢复良好。供体心脏的保护、围术期�Objective To determine the influence of normal pulmonary artery pressure, and mild to moderate and severe pulmonary hypertension on the early hemodynamies, morbidity, and mortality after orthotopie heart transplantations. Methods Sixty-seven heart disease patients, 54 males and 13 females, aged （46.4 ± 14.6） , including isehemie heart diseases （ n = 16） , myoeardiopathy （ n = 43 ） , and other heart diseases （ n = 8 ） , underwent orthotopic heart transplantation. Before and after transplantation routine fight heart catheterization was conducted. According to the preoperative pulmonary arterial pressure the patients were divided into 3 groups： Group Ⅰ （n = 15 ） without pulmonary hypertension （PH） with the pulmonary vascular resistance （PVR） ≤2.5 Wood＇s units; Group Ⅱ （n = 42 ） with mild to moderate PH with the PVR between 2.5 and 5.0 Wood＇s units; and Group Ⅲ （n =10） with severe PH with the PVR≥ 5.0 Wood＇s units. Heart rate （HR）, mean artery pressure （MAP）, central venous pressure （CVP） , mean pulmonary artery pressure （MPAP）, pulmonary artery wedge pressure （PAWP）, PVR, cardiac output index （CI）, and mixed venous oxygen saturation （SvO2 ） were measured preoperatively, immediately and 12, 24, and 48 hours postoperatively. 1, 3, and 7 days, and 1 and 3 months post-operatively eehoeardiography was eondueted to measure the left ventrieular end-diastolic diameter （LVEDD）, left ventficular ejection fraction （EF）, mitral valvular regurgitation （MVR）, and tricuspid valvular regurgitation （TVR）. Postoperative complications and mortality were recorded. Results The 30-day mortality was zero in all 3 groups. The cardiovascular support used for weaning CPB and postoperative period included dopamine, ephedrine and isoproterenol. In addition, nitroglycerin, NO and iloprost were administered for pulmonary artery vasodilation if the pulmonary artery pressure was higher than 45 mm Hg. The EF value of Group Ⅲ was significantly lower

关 键 词：心脏移植 高血压 肺性 围手术期 血液动力学 回顾性研究 

分 类 号：R654.2[医药卫生—外科学]