心脏杂交手术联合肺移植术治疗艾森曼格综合征1例临床分析  

Clinical analysis of heart hybrid procedure repair plus lung transplantation for Eisenmenger syndrome in one case

作　　者：王跃斌[1] 李丰科[1] 丁志丹[1] 方泽民[1] 赵凯 冯敏[2] 刘刚[2] 王勇[3] 金峰[3] 黄明君[4] 张新[5] 赵高峰[1] WANG Yue-bin;LI Feng-ke;DING Zhi-dan;FANG Ze-min;ZHAO Kai;FENG Min;LIU Gang;WANG Yong;JIN Feng;HUANG Ming-jun;ZHANG Xin;ZHAO Gao-feng(Department of Thoracic Surgery/Lung Transplantation Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Surgical ICU,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Anesthesiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;In Vitro Support Center,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Cardiac Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第一附属医院胸外科/肺移植外科,河南郑州450052 [2]郑州大学第一附属医院外科ICU,河南郑州450052 [3]郑州大学第一附属医院麻醉科,河南郑州450052 [4]郑州大学第一附属医院体外支持中心,河南郑州450052 [5]郑州大学第一附属医院心脏外科,河南郑州450052

出　　处：《中华实用诊断与治疗杂志》2022年第9期865-869,共5页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的 观察心脏杂交手术联合肺移植术治疗1例艾森曼格综合征的临床效果。方法 1例室间隔缺损合并动脉导管未闭导致重度肺动脉高压、艾森曼格综合征患者,女,30岁,行心脏杂交手术联合肺移植术治疗。先行体外膜肺氧合下经皮动脉导管未闭封堵术,再行右侧开胸体外循环下室间隔缺损修补术,后行左侧开胸左肺移植术。观察患者术中及术后临床资料。结果 手术时间13 h,术中体外循环支持时间130 min,出血量3 000 mL,手术过程顺利,术后患者发绀较术前减轻,心脏未闻及明显杂音。术后42 h撤除体外膜肺氧合;术后第3天X线胸片提示左肺膨胀可,与胸腔大小匹配,心脏超声心动图显示肺动脉压由术前107 mm Hg降为术后48 mm Hg,术后左室射血分数62%(术前65%);术后第4天撤离呼吸机,撤机后吸氧4 L/min下,pa(O)由术前50.8 mm Hg升高至147 mm Hg;术后第6天胸部CT示双侧胸腔少量积液,封堵器位置良好;术后第7天谷丙转氨酶36 u/L,谷草转氨酶26 u/L,血肌酐51μmol/L,白蛋白34.2 g/L;术后患者出现阵发性室上性心动过速,给予普罗帕酮90 mg静脉注射后转律恢复窦性心律。术后第7天生命体征平稳(体温36.9℃,呼吸频率20次/min,心率96次/min,血压110/51 mm Hg,血氧饱和度98%),目前仍在院康复中。结论 对部分简单性先天性心脏病(如房间隔缺损、室间隔缺损、动脉导管未闭等)合并艾森曼格综合征患者,行心脏杂交手术联合肺移植术治疗早期效果良好,远期疗效有待进一步观察。Objective To observe the clinical efficacy of heart hybrid procedure repair combined with lung transplantation on Eisenmenger syndrome in one patient.Methods One female patient aged 30years was diagnosed severe pulmonary hypertension and Eisenmenger syndrome caused by ventricular septal defect(VSD)and patent ductus arteriosus(PDA)and was performed hybrid procedure combined with lung transplantation including transcatheter duct occluder for PDA supported by extracorporeal membrane oxygenation,followed by right thoracotomy cardiopulmonary bypass for VSD,and left thoracotomy left lung transplantation.The intraoperative and postoperative clinical data was observed.Results The operation lasted 13h.The intraoperative cardiopulmonary bypass support time was 130 min,and the blood loss was3 000mL.The operation went smoothly.After operation,the cyanosis was relieved,and no obvious heart murmur was detected.Extracorporeal membrane oxygenation was removed in 42hafter operation.On the third day after surgery,chest X-ray showed that the left lung was distended,matching the size of the chest cavity.Echocardiography showed that the pulmonary artery pressure decreased from 107 mm Hg before surgery to 48 mm Hg after surgery,and the left ventricular ejection fraction was from 65%to 62%.On the fourth day after surgery,the ventilator was evacuated,and the pa(O)increased from 50.8mm Hg to 147mm Hg under the oxygen at gas flow of 4L/min.On the sixth day after surgery,chest CT showed a small amount of bilateral pleural effusion,and the occluder was in good position.On the seventh day after surgery,alanine aminotransferase was 36u/L,aspartate aminotransferase was 26u/L,serum creatinine was 51μmol/L,and albumin was 34.2g/L.After surgery,intermittent supraventricular tachycardia occurred,and the rhythm returned to normal after intravenous injection of 90mg propafenone.On the seventh day after surgery,the vital signs were stable,with the temperature of 36.9℃,respiratory frequency of 20 breaths/min,heart rate of 96beats/min,blood pressure

关 键 词：肺移植 心脏杂交手术 室间隔缺损 动脉导管未闭 艾森曼格综合征 

分 类 号：R654.2[医药卫生—外科学] R655.3[医药卫生—临床医学]