植入式心室辅助装置逆转衰竭心脏重构并撤除1例及文献复习  

One case of reverse remodeling and weaning for heart failure after ventricular assist device implantation and literature review

作　　者：陈海波 王现强 姜福清 杜娟 江勇 赵怀玉 李立环 杨晓涵 胡盛寿[1] Chen Haibo;Wang Xianqiang;Jiang Fuqing;Du Juan;Jiang Yong;Zhao Huanyu;Li Lihuan;Yang Xiaohan;Hu Shengshou(Department of Cardiac Surgery,Fuwai Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College(CAMS&PUMC),National Center for Cardiovascular Diseases,State Key Laboratory of Cardiovascular Disease,Beijing 100037,China;Department of Cardiac Surgery,Shenzhen Hospital,Fuwai Hospital,Chinese Academy of Medical Sciences,Shenzhen 518000,China)

机构地区：[1]国家心血管病中心,心血管疾病国家重点实验室北京协和医学院,中国医学科学院,阜外医院心外科,北京100037 [2]中国医学科学院阜外医院深圳医院心外科,深圳518000

出　　处：《中华心力衰竭和心肌病杂志（中英文）》2022年第2期120-126,共7页Chinese Journal of Heart Failure and Cardiomyopathy

基　　金：深圳三名工程项目(SZSM201911018);深圳市医学重点学科建设项目(SZXK080);广东省引进创新创业团队项目(2019ZT08Y481)。

摘　　要：目的探讨长期可植入式心室辅助血泵逆转衰竭心脏重构的疗效。方法阜外医院深圳医院2019年7月对1例衰竭心脏合并巨大左心室患者进行心室辅助装置CH-VAD血泵植入术及主动脉瓣置换术治疗,长期随访观察其心室逆转重构过程,利用经胸超声心动图、X胸片、血液学定期监测,采用纽约心脏协会(NYHA)心功能分级、6分钟步行距离、心肺运动试验来评估活动耐量康复过程。结果患者植入血泵后早期转速设置在2900 r/min,流量3.5~3.9 L/min之间,主动脉瓣开放次数与心动周期比值从术后早期0逐渐增加到1∶4、1∶2及1∶1。患者携带CH-VAD血泵生存730天,左心室舒张末径从术前112 mm逐渐缩小到50 mm,左心室射血分数从术前19%增加到55%,心胸比显著缩小(0.82比0.46)。术后3月后心功能恢复至NYHA心功能Ⅰ级,6分钟步行距离550米。将CH-VAD血泵转速从2600 r/min逐步降低至1800 r/min,心率在59~66次/分,平均动脉压82~85 mmHg,肺小动脉楔压在5~7 mmHg之间,经评估后自体心脏功能完全恢复正常,给予撤除CH-VAD血泵。患者术后22天顺利出院,随访1年无心脏衰竭发作和心律失常发生。结论长期可植入式心室辅助血泵可逆转心肌重构,对衰竭心脏功能恢复有较好疗效。Objective To investigate the efficacy of long-term implantable ventricular assist blood pump in reversing cardiac remodeling in failure.METHODS A patient with heart failure complicated with giant left ventricle was treated with ventricular assist device CH-VAD blood pump implantation and aortic valve replacement in Shenzhen Hospital of Fuwai Hospital in July 2019.The process of ventricular reverse remodeling was observed during long-term follow-up.The rehabilitation process of activity tolerance was assessed by transthoracic echocardiography,chest X-ray and hematology regular monitoring,New York Heart Association,NYHA functional classification,6-minute walk distance and cardiopulmonary exercise test.Results The early rotational speed was set at 2900 rpm and the flow was 3.5~3.9 L/min after blood pump implantation.The ratio of aortic valve opening to cardiac cycle increased gradually from 0 to 1∶4,1:2 and 1∶1 in the early postoperative period.Patients with CH-VAD blood pump survived for 730 days,left ventricular end-diastolic diameter gradually decreased from 112 mm preoperatively to 50 mm,left ventricular ejection fraction increased to 55%,and cardiothoracic ratio significantly decreased(0.82 vs 0.46).Cardiac function recovered to NYHA class I with a 6-minute walk distance of 550 meters after 3 months.The rotation speed of CH-VAD blood pump was gradually reduced from 2600 to 1800 rpm,the heart rate was 59~66 beats/min,the mean arterial pressure was 82~85 mmHg,and the pulmonary arterial hair pressure(PAWP)was 5~7 mmHg.After evaluation,the autologous cardiac function completely returned to normal,and the CH-VAD blood pump was withdrawn.The patient was discharged uneventfully 22 days after surgery and was followed up for 1 year without heart failure episodes or arrhythmias.Conclusion Long-term implantable ventricular assist blood pump can reverse myocardial remodeling and has a good effect on the recovery of heart function in failure.Keywords provided by Ventricular Assist Device Failure:cardiac myocardial remod

关 键 词：心室辅助装置 衰竭心脏 心肌重构 撤除 

分 类 号：R654.2[医药卫生—外科学]