心脏移植后右心功能不全的处理36例  

Clinical treatment of right cardiac insufficiency after heart transplantation

作　　者：潘禹辰[1] 史锋[1] 轩永波[1] 朱中权[1] 罗爱国[1] 唐开维[1] 左艳[1] 展宇飞 药晨[1] 

机构地区：[1]解放军第一八一医院心脏中心,广西省桂林市541002

出　　处：《中华器官移植杂志》2014年第10期611-614,共4页Chinese Journal of Organ Transplantation

摘　　要：目的总结心脏移植术后右心功能不全的处理经验。方法2006年10月至2013年11月对51例终末期心脏病患者行原位心脏移植，36例受者在术后出现右心功能不全，使用强心、利尿等药物治疗以及使用连续性。肾替代治疗和体外膜肺氧合治疗。结果12例使用连续性肾替代治疗，5例使用体外膜肺氧合治疗，30d内死亡4例，因右心功能衰竭死亡3例，感染性休克死亡1例，术后早期并发症有急性肾功能衰竭3例，肺部感染2例，监护室停留时间5～18d。结论心脏移植术后右心功能不全是引起受者死亡的重要原因，强心、利尿等药物治疗效果不理想时尽早使用连续性肾替代治疗和体外膜肺氧合可以取得良好的治疗效果。Objective To summarize the clinical treatment of the right cardiac insufficiency after heart transplantation. Method From October 2006 to November 2013, 51 patients with end-stage heart disease after orthotopic heart transplantation therapy, including 36 cases of right cardiac insufficiency, were given cardiotonic and diuretic, or the continuous renal replacement therapy （CRRT） and extracorporeal membrane oxygenation （ECMO） therapy. Result Twelve cases were subjected to CRRT, and 5 cases to ECMO. Four cases died within 30 days, including 3 deaths due to right heart failure, and one death due to septic shock. Early postoperative complications included acute renal failure （3 cases）, and pulmonary infection （2 cases）. The care unit stay was 5-18 days. Conclusion Right cardiac insufficiency after heart transplantation is the important cause leading to the death of recipients. When the curative effectiveness of cariotonic and diuretic treatments is not satisfactory, the use of CRRT and ECMO is recommended as early as possible.

关 键 词：心脏移植 右心功能不全 连续性肾替代治疗 体外膜肺氧合 

分 类 号：R654.2[医药卫生—外科学]