心脏移植心肌保护策略  

Myocardial Protection Strategy in Heart Transplantation

作　　者：黑飞龙[1] 王仕刚[1] 于坤[1] 李景文[1] 龙村[1] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院体外循环科,北京100037

出　　处：《中国体外循环杂志》2009年第3期166-168,共3页Chinese Journal of Extracorporeal Circulation

摘　　要：目的总结63例原位心脏移植的心肌保护的管理经验。方法供心心肌保护为从主动脉根部灌注冷4℃St.Thom as液1 000mL使供体心脏迅速停搏,再经主动脉根部一次灌注4℃威斯康星大学心脏保护液（UW液）或康斯特心脏保护液（HTK液）2 000 mL进行脏器保护,升主动脉开放前灌注温血低钾停搏液。结果热缺血时间（7.2±1.3）m in,冷缺血时间（165.7±52.4）m in,体外循环时间（178.3±31）m in,体外循环并行辅助时间（75.3±28.9）m in,其中38例为升主动脉开放后自动复跳,术后机械通气时间（26.7±25）h,其中41例24内拔除气管插管,最短者术后2 h在手术室拔除气管插管,外科术后隔离监护室时间（9±4）天,术后一个月患者生活能自理,超声心动图显示左室射血分数55%～73%（63.6±6.0）%。所有患者均存活。结论有效的供体心脏保护措施对心脏移植的成功起着非常关键的作用。OBJECTIVE To summarize the experiences of myocardial protection in donor heart on 63 cases of orthotopic heart transplantation. METHODS The donor hearts were arrested with aorto perfusion using St. Thomas solution at 4℃. Then the donor hearts were perfused with 2000 mL UW solution or HTK solution in 4℃ and preserved in ice saline. Ice mud was covered on the donor heart in the period of anastomosis. The lower potassium concentration cardioplegia solution was perfused before unclamping aorta. RESULTS The cardiopulmonary bypass（CPB） time was （178.3 ± 31 ） rain, and the warm and cold ischemia time was respectively （7.2 ± 1. 3 ） min and （ 165.7 ℃ 52.4） min. 38 cases recovered heart beats automatically. Left ventricular ejection fractions were 55% ～ 73 % （63.6 ± 6.0 ）% a month postoperatively. All cases survived. CONCLUSION Proper donor heart myocardial protection strategy are the key to success in heart transplant operations.

关 键 词：心肌保护 心脏移植 体外循环 

分 类 号：R654.2[医药卫生—外科学]