摘要
目的总结133例心脏移植的供心获取及其保护经验并做回顾分析。方法武汉协和医院心脏外科2008年9月至2014年5月共完成133例原位心脏移植,其中非停搏供心103例,停搏供心30例。非停搏供心经主动脉根部灌注4℃改良St.Thomas液,供心快速停搏,取下供心后再灌注8℃康斯特保护液(HTK液)并置于HTK液中低温浸泡保存。停搏供心经主动脉根部灌注8℃HTK液,取下供心后再灌注HTK液并置于HTK液中保存。在供心修剪时均经主动脉根部再次灌注HTK液。结果非停搏供心组,92例供心自动复跳,11例电除颤复跳;热缺血时间(3.25±2.25)min,冷缺血时间(253.22±136.73)min,术后主动脉内球囊反搏(IABP)使用率9.5%,术后三周左室射血分数(LVEF)值(65.52±6.72)%,术后一年生存率92.55%。停搏供心组,23例供心自动复跳,7例电除颤复跳。热缺血时间(5.78±2.82)min,冷缺血时间(179.12±52.43)min,术后IABP使用率10.1%,术后三周LVEF值(65.78±7.22)%,术后一年生存率91.07%。结论本中心对两类供心采用不同获取及保护方法均确切有效,扩大了边缘供心的使用范围,提高了手术疗效。
Objective To summarize the management experiences of donor heart protection in 133 orthotopic heart transplantation patients. Methods From Sep. 2008 to May 2014, 133 patients with end-stage heart disease underwent orthotopic heart transplantation in Wuhan Union hospital. Among them, 103 cases received non-arrest donor heart （ groupⅠ） and 30 cases received arrest donor heart （ groupⅡ） . In Group I, 4℃ ST. Thomas solution was infused through aortic roots after aorta was cross clamped to make donor hearts arrested quickly first, then the donor hearts were soaked and preserved and transported in 8℃ HTK solution;In groupⅡ, 8℃HTK solution was infused through aortic roots after aorta was cross clamped, and the donor hearts were preserved in HTK solution. Results In group I, 92 patients recovered heart beating automatically after clamp removed, and 11 patients recovered heart beating by electric defibrillation. The donor heart warm ischemic period was （3.25±2.25） min and cold ischemic period was （253.22±136.73） min. Postoperative utilization rate of IABP was 9.5%, EF values of three weeks after heart transplantation was （65.52 ± 6.72）%, one year survival rate was 92.55%. In group II, 23 cases recovered heart beating automatically after clamp removed and 7 patients recovered heart beating by electric defibrillation. The donor heart warm ischemic period was （ 5. 78 ± 2. 82） min and cold ischemic period was （179.12±52.43） min. Postoperative utilization rate of IABP was 10.1%, EF values of three weeks after heart transplantation was （65.78±7.22）, one year survival rate was 91.07%. Conclusion Using different donor heart procurement and efficient heart preservation during perioperative period are considerably important for a successful heart transplantion, it expand the use of edging donor hearts and improve the success rate of heart transplantation.
出处
《中国体外循环杂志》
2014年第4期219-221,244,共4页
Chinese Journal of Extracorporeal Circulation
关键词
心脏移植
供心保护
器官保存液
Heart transplantation
Donor heart protection
Organ preservation solution
