五例原位心脏移植手术患儿的围术期护理  

Perioperative care of five children with orthotopic heart transplantation

作　　者：徐邦红 李明兄 史爱国 杨玉忠[1] 李梅[1] 彭明琦[1] 莫绪明[1] XU Banghong;LI Mingxiong;SHI Aiguo;YANG Yuzhong;LI Mei;PENG Mingqi;MO Xuming(Department of Cardiothoracic Surgery,Children s Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学附属儿童医院心胸外科,江苏南京210019

出　　处：《现代医学》2023年第12期1762-1766,共5页Modern Medical Journal

摘　　要：目的:总结5例原位心脏移植手术患儿的围术期护理经验。方法:2020年8月至2022年7月本中心共完成心脏移植手术5例,受者年龄(100.60±55.49)个月,体重(30.60±14.43) kg。术前诊断扩张型心肌病1例,伴有肺动脉高压、二尖瓣及三尖瓣返流、心功能Ⅳ级;肥厚型心肌病1例;复杂先天性心脏病1例,外院3次主动脉瓣膜手术均失败,需体外膜肺氧合(ECMO)辅助;心肌致密化不全2例。5例患儿均在全麻中低温体外循环下行双腔静脉法同种异体原位心脏移植手术,体外循环时间(208.80±30.91) min,主动脉阻断时间(108.80±12.38) min,供心冷缺血时间(431.00±84.60) min。术后常规给予脏器功能支持,抗排异治疗以及预防感染。结果:5例患儿围术期全部存活,随访5~22个月,均心功能良好,肝肾功能无明显异常,血糖、血脂正常,未发现免疫抑制剂相关并发症。结论:心脏移植手术操作复杂、体外循环时间长、术后并发症多,护理人员需掌握心脏移植护理要点及难点,严密监护,及时发现问题,尽早干预,方可保障心脏移植患儿安全,提高手术成功率。Objective:To summarize the perioperative nursing experience of five children with orthotopic heart transplantation.Methods:Five children underwent heart transplantation were collected from August 2020 to July 2022.The recipients were(100.60±55.49)months old,and the youngest one was 1 year and eleven months and weighed(30.60±14.43)kg.One case was diagnosed with dilated cardiomyopathy before operation,accompanied by pulmonary hypertension,mitral and tricuspid regurgitation and cardiac function gradeⅣ.One case was diagnosed with hypertrophic cardiomyopathy.One case was complex congenital heart disease failed in aortic valve operation for three times,assisted by extracorporeal membrane oxygenation(ECMO).Two cases were diagnosed with noncompaction of myocardium.Five children were operated under general anesthesia with hypothermic extracorporeal circulation for double vena cava allograft orthotopic heart transplantation.The duration of cardiopulmonary bypass was(208.80±30.91)min,the duration of aortic occlusion was(108.80±12.38)min,and the duration of donor heart cold ischemia was(431.00±84.60)min.Postoperative routine organ function support,anti-rejection treatment and infection prevention were routinely provided.Results:All five children survived during the perioperative period,and were followed up from 5 months to 22 months with good cardiac function,no obvious abnormality in liver and kidney function,normal blood sugar and blood lipid range,and no complications related to immunosuppressants were found.Conclusion:Heart transplantation is a complex operation,long extracorporeal circulation time,and many postoperative complications.To ensure the safety of children with heart transplantation and improve the success rate of surgery,the nursing staff should grasp the key points and difficulties of heart transplant nursing,monitor closely,find problems in time,and intervene as early as possible.

关 键 词：心脏移植 儿童 围术期护理 

分 类 号：R473.72[医药卫生—护理学]