24例心血管手术后再次开胸心脏移植患者的临床研究  

Clinical study of heart transplantation after cardiovascular surgery in 24 patients

作　　者：吴敏[1] 黄劲松[1] 麦明杰[1] 吴怡锦 吴梅芬 WU Min;HUANG Jin-song;MAI Ming-jie;WU Yi-jin;WU Mei-fen(Department of Cardiac Surgery,Guangdong Cardiovascular Institute,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510100,China)

机构地区：[1]广东省心血管病研究所心外科广东省人民医院(广东省医学科学院),广州510100

出　　处：《岭南心血管病杂志》2020年第5期525-529,共5页South China Journal of Cardiovascular Diseases

基　　金：广东省医学科学技术研究基金项目(项目编号:A2020002)。

摘　　要：目的探讨心血管手术后再次开胸行心脏移植患者的临床效果。方法回顾性分析2017年2月至2020年8月之间接受过心血管手术再次开胸行心脏移植24例患者,将同时期非心血管手术后的140例心脏移植患者作为对照组。通过观察对比两组患者的左心室收缩末期内径(left ventricular end systolic diameter,LVESD),左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD),左心室射血分数(left ventricular ejection fraction,LVEF),肌酐浓度,估算肾小球滤过率(estimated glomerular filtration rate,eGFR),冷缺血时间,体外循环(cardiopulmonary bypass,CPB)时间,主动脉阻断(aortic cross clamp,ACC)时间,冷沉淀,血浆、红细胞和血小板的使用,以及重症监护病房(intensive care unit,ICU)时间与住院时间等指标来评价临床效果。结果24例患者中1例围术期死亡,4例患者死于1年随访期内。研究组患者围术期的生存率为95.8%;研究组患者1年生存率低于对照组,差异有统计学意义[79.2%(19/24)vs.88.6%(124/140),P<0.05]。死亡原因是感染,多器官功能衰竭与排斥。两组患者术前LVESD,LVEDD,LVEF,eGFR,冷沉淀,血浆、红细胞和血小板的使用以及术后ICU停留时间与住院时间比较,差异无统计学意义(P>0.05)。两组患者术前肌酐浓度、供心冷缺血时间、CPB时间、ACC时间比较,差异有统计学意义(P<0.05)。两组患者术后肌酐浓度均比术前明显升高,差异有统计学意义(P<0.05)。结论心血管手术后心脏移植比常规的心脏移植患者情况更加复杂,要在术前综合评估手术风险。合理安排好供心获取时间,减少冷缺血时间,做好感染筛查,术前维护心脏、肝、肾等重要器官功能,可以提高心血管手术后再次开胸心脏移植的生存率。Objectives To evaluate the clinical effect of patients underwent heart transplantation after cardiovascular surgery.Methods A retrospective analysis was conducted on 24 patients who had undergone cardiac surgery to undergo heart transplant by re-thoracotomy from February 2017 to August 2020 in Guangdong Provincial People's Hospital.In the same period,140 patients who underwent routine heart transplantation were selected as control group.Left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),concentration of creatinine,estimated glomerular filtration rate(eGFR),cold ischemia duration,cardiopul⁃monary bypass(CPB)duration,aortic cross clamp(ACC)duration,cryoprecipitate,application of plasma,red blood cells and platelets,intensive care unit(ICU)duration and hospitalization duration were compared between the two groups to evaluate the clinical effect.Results Among the 24 patients,1 died during perioperative period and 4 patients died within one year follow-up period.The perioperative survival rate of the study group was 95.8%.One-year survival rate of observation group was significantly lower than that of control group[79.2%(19/24)vs.88.6%(124/140),P<0.05].The causes of death were infection and multiple organ failure.There were no significant differences in LVESD,LVEDd,LVEF,eGFR,cryoprecipitate,application of plasma,red blood cells and platelets,ICU duration and in-hospital duration between the two groups(P>0.05).There were significant differences in preoperative concentration of creatinine,cold ischemia duration,CPB duration and ACC duration between study group and control group(P<0.05).Concentrations of creatinine after surgery were significantly higher than those before surgery in both groups(P<0.05).Conclusions Patients underwent heart transplantation after cardiovascular surgery have more complicated situation when compared with routine operation patients.Preoperative comprehensive assessment of surgical risk should be evaluated for

关 键 词：心脏移植 心血管手术 感染 肾功能衰竭 再次开胸手术 

分 类 号：R654.2[医药卫生—外科学]