边缘供心临床应用的单中心效果分析  

Single-center effect analysis of clinical application of marginal donor heart

作　　者：吴智勇[1] 王志维[1] 任宗力[1] 阮永乐[1] 任伟[1] 胡锐[1] 余岸峰 石烽 左一凡 Wu Zhiyong;Wang Zhiwei;Ren Zongli;Ruan Yongle;Ren Wei;Hu Rui;Yu Anfeng;Shi Feng;Zuo Yifan(Department of Cardiovascular Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院心血管外科,430060

出　　处：《中华胸心血管外科杂志》2020年第4期222-226,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：湖北省自然科学基金(2018CFB141);武汉市应用基础研究项目(2017060201010151);武汉大学人民医院引导基金项目(RMYD2018M22)。

摘　　要：目的:回顾性分析边缘供心使用经验,探讨边缘供心的使用原则和风险防控。方法:2018年1月至2018年12月期间31例终末期心脏病患者实施原位心脏移植术,均采用双腔法吻合。包括单纯心脏移植28例,心肺联合移植2例,心肾联合移植1例。将患者按照供心来源分为常规供心组(5例)和边缘供心组(26例)。比较两组患者心脏移植术后各指标。结果:两组患者术后均未使用体外膜肺氧合和主动脉球囊反搏,无急性排斥反应,无神经系统并发症发生。与常规供心组相比,边缘供心组体外循环时间明显延长,差异有统计学意义( P<0.05);术后住院时间、带管时间、ICU滞留时间、心电图异常率、左心室射血分数、血液生化指标等方面差异均无统计学意义( P>0.05)。术后随访患者0.5~1.0年,随访率100%,期间边缘供心组1例心肺联合移植患者因多器官功能衰竭于术后1个月死亡;其他患者均无三尖瓣中度以上反流发生,无再次心衰发生;两组在心律失常发生率、左心室射血分数、感染和血液生化指标等方面差异均无统计学意义( P>0.05)。 结论:应用边缘供心并未对心脏移植患者术后近期生存率和恢复产生明显影响,中远期效果有待进一步随访。Objective To retrospectively analyze the experience of our center in the use of marginal donor heart,and to explore the principle of use and risk control of marginal donor heart.Methods A total of 31 patients with end-stage heart disease underwent orthotopic heart transplantation in our center from January 2018 to December 2018,including 28 cases of pure heart transplantation,2 cases of combined heart-lung transplantation,and 1 case of combined heart-kidney transplantation.26 of the 31 cases were marginal donor hearts.These patients were all anastomosed by a double lumen method.Results The rates of postoperative use of ECMO,IABP and acute rejection were zero in this study.The time of cardiopulmonary bypass in the marginal donor group was significantly longer compared with the conventional donor group(P<0.05),but there was no significant difference between the two groups in terms of hospitalization time,mechanical ventilation time,ICU stay time,abnormal rate of ECG,LVEF and blood biochemical indexes(all P>0.05).The postoperative follow-up rate was 100%in the two groups.One case of combined heart-lung transplantation in the marginal donor group died of multiple organ failure in the first month after surgery.During the postoperative follow-up period,the incidence of moderate to severe tricuspid regurgitation and the incidence of recurrent heart failure were zero in the two groups.There was no significant difference in the incidence of arrhythmia,LVEF,infection and blood biochemical parameters.Conclusion The application of marginal donor heart has no significant effect on the short-term survival rate and recovery of patients after heart transplantation,but the long-term effect needs further follow-up.

关 键 词：心脏移植 边缘供体 终末期心脏疾病 治疗结果 

分 类 号：R654.2[医药卫生—外科学]