心肝联合移植一例报告  

Intensive care on one case of combined heart-liver transplantation

作　　者：史嘉玮[1] 董念国[1] 刘金平[1] 张菁[1] 蔡杰[1] 李平[1] 陈剑锋[1] 肖诗亮[1] 郑启[2] 昌熊俊[2] 

机构地区：[1]华中科技大学同济医学院附属协和医院心血管外科,武汉430022 [2]华中科技大学同济医学院附属协和医院肝胆外科,武汉430022

出　　处：《中华器官移植杂志》2012年第9期536-538,共3页Chinese Journal of Organ Transplantation

摘　　要：目的总结原位心肝联合移植1例的诊治体会。方法2011年11月24日施行了1例原位心肝联合移植，患者原发病为先天性三尖瓣下移畸形、三尖瓣置换术后5年，合并淤血性肝硬化，术前心功能Ⅳ级，肝功能Child-Pugh评分为B级。手术采用分次体外循环辅助的方式，先建立腔静脉一主动脉转流完成心脏移植，然后建立股静脉一升主动脉转流完成肝移植，最后停机中和。术中主动脉阻断时间为54min，无肝期为38min，3次体外循环转流时间共计199min，手术耗时共计517min。给予巴利昔单抗联合甲泼尼龙免疫诱导治疗，并采用他克莫司＋吗替麦考酚酯＋泼尼松的方案抗排斥反应，术后加强护肝治疗、抗感染治疗和营养支持治疗。结果术后第78天受者因多器官功能衰竭而死亡。受者接受呼吸机辅助治疗的时间为78d，因术后出现低氧血症而接受体外膜肺氧合辅助治疗的时间为63d。结论心肝联合移植术是治疗心肝功能衰竭的有效手段，手术前后的管理具有较高要求。Objective To summarize the diagnosis and treatment of one case of combined heart- liver transplantation. Methods On November 24, 2011, one case of combined heart liver transplantation was performed on a patient with Ebstein＇s anomaly and tricuspid valve replacement after 5 years, complicated with congestive cirrhosis, liver failure decompensation, preoperative heart failure Ill degree and B grade of liver function Chil＆Pugh score. The operation was done with the graded cardiopulmonary bypass-assisted mode： first creating the vena cav^aortic bypass to complete heart transplantation, second creating the femoral vein-ascending aorta bypass to complete liver transplantation, and third stopping and neutralizing. The aortic cross-clamping time was 54 rain and the an-hepatic phase was 38 rain. The total time of three times of cardiopulmonary bypass was 199 rain and the total time-consuming of operation was 517 rain. The patient was given basiliximab ＋ methylprednisolone for immune induction therapy, and tacrolimus ＋ mycophenolate mofetil ＋ prednisone solution for anti-rejection. After operation, livevprotecting treatment, anti-infection therapy and nutrition support therapy were given. Results The recipient died of multiple organ failure after 78 days. The mechanical ventilation treatment duration for this recipient was 78 days and ECMO adjuvant therapy for postoperative hypoxemia time lasted 63 days. Conclusion The combined heart- liver transplantation is an effective measures for treatment of heart and liver failure.

关 键 词：心肝联合移植 围手术期医护 

分 类 号：R657.3[医药卫生—外科学] R654.2[医药卫生—临床医学]