摘要
目的 探讨辅助循环治疗应用于心脏移植围术期的临床疗效.方法 回顾性分析山东省千佛山医院2012年7月1日至2017年10月31日13例心脏移植患者围术期应用主动脉内球囊反搏术(IABP)、体外膜肺氧合(ECMO)和连续肾脏替代疗法(CRRT)辅助循环治疗的临床资料,其中应用ECMO 6例(ECMO+ IABP 3例),IABP辅助7例(IABP+ CRRT 1例).根据患者术后存活情况、心功能、肾功能等数据评估辅助循环治疗对心脏移植术后发生移植物功能障碍的治疗效果.结果 6例单独使用IABP者5例成功撤除,1例应用IABP+ CRRT辅助成功,ECMO或ECMO+ IABP辅助者成功率50%,而2例术中安置ECMO+IABP者全部成功.4例死者中,2例患者术中开始应用ECMO辅助,分别于术后第5天死于右心衰竭和术后第7天死于多脏器衰竭,1例受者术后安置ECMO+IABP辅助,术后第11天死于多脏器衰竭,1例IABP辅助者术后第3天发生脑出血于术后第13天死亡.其余患者术后各项功能恢复良好.结论 心脏移植围术期合理应用IABP、ECMO和CRRT辅助循环治疗可作为心脏移植术后低心排、心肌收缩不良等移植物功能障碍的有效治疗手段,但急性排斥反应和器官移植物的衰竭仍需注意.
Objective To analyze the application of IABP,ECMO and other auxiliary circulatory treatment cases in the perioperative period of heart transplantation,and summarize the clinical efficacy and application experience.Methods Retrospective analysis was conducted on the clinical data of thirteen patients with cardiac transplantation(IABP,ECMO,etc.)during the perioperative period from July 1,2012 to October 31,2017.There were six ECMO applications(including three cases of ECMO+IABP application)and seven cases of IABP(including one case of IABP+CRRT).The prognosis of heart transplantation was analyzed according to the patient survival rate,cardiac function and renal function.Results Five of the six independent IABP auxiliaries successfully removed IABP.One application of IABP+CRRT assisted success.The success rate of ECMO or ECMO+IABP is 50%.The ECMO+IABP was successfully resettled in nearly 2 cases.Of the four deceased patients,two of them received ECMO assistance during surgery.They died of right heart failure on the fifth postoperative day and multiple organ failure on the seventh postoperative day.One patient received postoperative ECMO+IABP assistance and died of multiple organ failure on the eleventh day after surgery.One IABP-assisted cerebral hemorrhage occurred on the third postoperative day and died on the thirteenth postoperative day.All other patients recovered well after surgery.Conclusion Appropriate application of IABP,ECMO,and other auxiliary circulation therapy during the perioperative period of heart transplantation can improve the success rate of heart transplantation.
作者
乙飞
厉泉
王勇
陈善良
毕严斌
李敏
李培杰
许莉
车东阳
王东
刘天起
Yi Fei;Li Quan;Wang Yong;Chen Shanliang;Bi Yanbin;Li Min;Li Peijie;Xu Li;Che Dongyang;Wang Dong;Liu Tianqi(Weifang Medical College Clinial Medical College,Weifang 261053,China)
关键词
心脏移植
手术期间
辅助循环
Heart transplantation
Intraoperative period
Assisted circulation
