冠脉造影在心脏移植供体评估中的应用  

Application of coronary angiography in donor assessment of cardiac transplantation

作　　者：浮志坤[1] 杨慧娟[1] 张曙光 杨恒[1] 杜鹏 朱勇锋[1] 张向立[1] FU Zhi-kun;YANG Hui-juan;ZHANG Shu-guang;YANG Heng;DU Peng;ZHU Yong-feng;ZHANG Xiang-li(The Seventh People's Hospital of Zhengzhou,Cardiovascular disease hospital cardiac surgery of Zhengzhou,Zhengzhou 450012,China)

机构地区：[1]郑州市第七人民医院(郑州市心血管病医院)心脏外科,郑州450012

出　　处：《医药论坛杂志》2020年第2期42-44,共3页Journal of Medical Forum

摘　　要：目的总结15例心脏移植供体中5例行冠状动脉造影评估供心冠脉的方法和经验。方法郑州市第七人民医院心脏外科2018年4月—2019年4月期间连续获取15例供心,5例于移植前行冠状动脉造影评估供心冠脉,3例造影是在供心获取前完成,2例造影是在供心获取后完成。其中1例供心因严重三支病变被弃用,1例供心术前发现右冠状动脉重度狭窄,术中行冠状动脉旁路移植术。顺利完成14例原位心脏移植术。结果14例受者术后早期无死亡(30天内),1例于术后10小时出现心脏骤停,心肺复苏后予以ECMO辅助74小时顺利撤机。术后随访1~13个月,死亡2例,均为重症感染,1例出现在移植术后40天,1例出现在移植术后2个月。余受者心功能均恢复至I级。对比造影组供心和未行造影组供心的主动脉阻断时间、体外循环时间、术后呼吸机辅助时间、围术期盐酸肾上腺素使用时间、主动脉球囊反搏使用率、围术期生存率均无统计学差异(P<0.05)。结论冠状动脉造影能够准确评估心脏移植供心的冠脉整体状况,能够及时的筛选发现边缘供心,为提高心脏移植供心的质量以及保障心脏移植手术的顺利成功提供保障。Objective To summarize the methods and experience of coronary angiography in the evaluation of 5 coronary heart tumors in 15 donors.Methods Department of Cardiology, the Seventh People’s Hospital of Zhengzhou City, from April 20 to April 2019, 15 patients received continuous heart, 5 patients underwent coronary angiography to evaluate the coronary artery before transplantation, and 3 cases were completed before the heart was obtained. 2 cases of angiography were completed after the heart was obtained. One of them was abandoned for severe three-vessel disease, and one patient was found to have severe stenosis of the right coronary artery before surgery. Coronary artery bypass grafting was performed during operation. Successful completion of 14 orthotopic heart transplantation.Results Fourteen patients had no death(30 days) in the early postoperative period, and one patient had cardiac arrest 10 hours after the operation. After cardiopulmonary resuscitation, ECMO assisted 74 hours to smoothly withdraw the machine. All patients were followed up for 1 to 13 months, 2 patients died, all were severe infections, 1 patient appeared 40 days after transplantation, and 1 patient appeared in 2 months after transplantation. The rest of the recipient’s heart function returned to level I. Comparison of aortic occlusion time, extracorporeal circulation time, postoperative ventilator assist time, perioperative period of epinephrine hydrochloride, aortic balloon counterpulsation rate, perioperative use in the contrast group There was no significant difference in the survival rate(P<0.05).Conclusion Coronary angiography can accurately assess the overall coronary heart condition of the heart transplant, and can timely screen and find the edge of the heart, to improve the quality of heart transplantation and to ensure the success of heart transplant surgery.

关 键 词：冠脉造影 心脏移植 供体评估 

分 类 号：R654.2[医药卫生—外科学]