小儿心脏移植的体外循环及供心保护策略  

The strategy of cardiopulmonary bypass and myocardial protection of donor heart in pediatric heart transplantation

作　　者：陈剑锋[1] 董念国[1] 孙图成[1] 

机构地区：[1]华中科技大学附属协和医院心脏大血管外科

出　　处：《临床心血管病杂志》2016年第4期364-366,共3页Journal of Clinical Cardiology

摘　　要：目的：总结10例小儿心脏移植的体外循环及供心保护策略。方法：回顾性分析我院2009-2015年共10例14岁以下小儿心脏移植的临床资料。手术在中低温、中度稀释体外循环完成,联合应用多种超滤方式。3例采用腔腔吻合方式,7例采用房房吻合方式。供心保护首先灌注冷改良St Thomas液20ml/kg,摘除供心后置入无菌标本袋内,经主动脉根部再次灌注4℃HTK液40~50ml/kg并将供心保存于其中。上台之前进行供心修剪,并灌注第2次4℃HTK液20ml/kg。结果：供心冷缺血时间为117~522（290±157）min,体外循环时间为71~217（123.6±46.7）min,升主动脉阻断时间为29~105（40.4±24.3）min。其中8例患者顺利停机,2例术后因早期移植物衰竭而使用ECMO。所有患者均康复并顺利出院,术后3周复查射血分数为（68±6.9）%,术后平均随访16个月尚无死亡病例。结论：重视体外循环管理与供心心肌保护,及时使用ECMO辅助是小儿心脏移植成功的关键。Objective：To summarize the experiences of cardiopulmonary bypass and donor heart myocardial protection in pediatric heart transplantation of 10 cases.Method：Between 2009 and 2015,10 patientsaged less than14 years underwent heart transplantation in our department.The clinical data was reviewed retrospectively.The surgery was performed under moderate hypothermic cardiopulmonary bypass with moderate blood dilution and ultra filtration,in the manner of cava-cava anastomosis in 7and atrium-atrium anastomosis in 3cases.The donor heart was arrested by 20ml/kg St.Thomas solution at 4℃.After being harvested,the donor heart was perfused with 40~50ml/kg HTK solution at 4℃ and then preserved in the same solution.Before surgery the donor heart was trimmed and perfused again with 20 ml/kg HTK solution at 4℃.Result：The cold ischemic time of donor hearts was 117~522（290±157）minutes.Total CPB time was 71~217（123.6±46.7）minutes with aorta clamp time 29~105（40.4±24.3）minutes.8cases weaned from CPB successfully and another 2cases was performed with ECMO because of early graft failure.All patients recovered and were discharged uneventfully.Follow-up was complete in all patients,with a mean follow-up of 16 months.There was no death or severe complication during the flow-up.Threeweeks after operation,the ejective fraction was improved to（68±6.9）%.Conclusion：The optimized strategy of CPB management,donor heart protection and ECMO support arethe key factors to the successful pediatric heart transplantation.

关 键 词：心脏移植 小儿 体外循环 心肌保护 体外膜肺氧合 

分 类 号：R654.2[医药卫生—外科学]