心脏移植患者术前肺动脉压力与术后并发症的关系及防治  

The Relation Between Preoperative Pulmonary Artery Pressure and Postoperative Complications in Heart Transplantation Patients and the Prevention and Treatment to Postoperative Complications

作　　者：廖中凯[1] 王巍[1] 宋云虎[1] 黄洁[2] 胡盛寿[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院心血管病研究所心脏外科,北京100037 [2]中国医学科学院北京协和医学院阜外心血管病医院心血管病研究所心脏移植科,北京100037

出　　处：《中国胸心血管外科临床杂志》2009年第5期348-352,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家科技支撑计划心;肺移植关键技术基金资助项目(2006BAI60B05)~~

摘　　要：目的分析心脏移植患者术前肺动脉压力和肺血管阻力（PVR）与术后右心功能不全、并发症发生和死亡的关系,总结围术期肺动脉高压的管理经验,以利于心脏移植术后患者早期心功能的恢复。方法125例接受同种原位心脏移植手术的患者,根据术前肺动脉收缩压（PASP）和PVR不同分为两组,肺动脉高压组（n=56）：术前PASP〉50 mm Hg或PVR〉5 Wood.U;对照组（n=69）：术前PASP≤50 mm Hg,PVR≤5 Wood.U。通过Swan-Ganz导管监测两组手术前心脏排血指数（CI）,手术前。Objective To analyze the relation between preoperative pulmonary artery pressure （PAP） and postoperative complications in heart transplant patients, and summarize the experience of perioperative management of pulmonary hypertension （PH）, to facilitate the early period heart function recovery of postoperative heart transplant patients. Methods A total of 125 orthotopic heart transplant patients were divided into two groups according to preoperative pulmonary arterial systolic pressure （PASP） and pulmonary vascular resistance （PVR）, pulmonary hypertension group （n=56）： preoperative PASP〉50mmHg or PVR〉5 Wood-U; control group （n=69）：preoperative PASP≤50 mmHg and PVR≤5 Wood · U. Hemodynamics index including preoperative cardiac index （CI） ,preoperative and postoperative PVR and PAP were collected by Swan-Ganz catheter and compared. The extent of postoperative tricuspid regurgitation was evaluated by echocardiography. Postoperative pulmonary hypertension was treated by diuresis, nitrogen oxide inhaling, nitroglycerin and prostacyclin infusion, continuous renal replacement therapy（CRRT） and extracorporeal membrane oxygenation （ECMO）. Results All patients survived except one patient in pulmonary hypertension group died of multi-organ failure and severe infection postoperatively in hospital. Acute right ventricular failure occurred postoperatively in 23 patients, 10 patients used ECMO support, 10 patients with acute renal insufficiency were treated with CRRT. 124 patients were followed up for 2 59 months, 7 patients died of multiple organ failure, infection and acute rejection in follow-up period, the survivals in both groups have normal PAP, no significant tricuspid regurgitation. No significant difference in cold ischemia time of donor heart, cardiopulmonary bypass（CPB） and circulation support time between both groups; but the patients of pulmonary hypertension group had longer tracheal intubation time in comparison with the patients of control group （65± 119 h vs.

关 键 词：心脏移植 肺动脉高压 肺血管阻力 右心功能不全 

分 类 号：R654.2[医药卫生—外科学]