37例心脏移植的体外循环管理经验

目的:总结37例原位心脏移植体外循环管理经验。方法:37名患者进行了同种异体心脏移植手术,术前心脏超声检查EF值平均(24.52±4.79)%;采用中度低温、轻中度血液稀释、中高流量体外循环灌注。术中监测血气和电解质,常规使用超滤技术和白蛋白。供心保护采用HTK心肌保护液,经主动脉根部灌注冷HTK心脏停搏液,快速取下心脏,并放置于冷HTK液中低温保存。结果:供心热缺血时间(7.7±1.7)min,冷缺血时间(194.52±121.57)min,体外循环时间(110.87±29.83)min。主动脉阻断时间为(47.83±8.91)min,平均动脉压55～85mmHg。37例患者均顺利脱离体外循环机。结论:良好的供心保护,体外循环过程中保持平均动脉压在60～80mmHg及晶胶比在0.45～0.60,血气和电解质的动态监测以及超滤和白蛋白的应用是心脏移植体外循环管理的关键。

Experiences of cardiopulmonary bypass for heart transplantation

Objective:To summarize the experiences of cardiopulmonary bypass(CPB) in thirty seven cases of orthotopic heart transplantation.Method:Thirty-seven orthotopic heart transplants were performed in our hospital,and their mean heart ejection fraction(EF) was 36.83±14.33 before operation.Slight hypothermia,slight hemodilution and high flow rate perfusion were used during the CPB,and the function of patients,heart,brain,lung,kidney and blood gas and electrolytes were measured and the ratio of crystal.Application of ultrafiltration and albumin before termination of bypass are essential.The cardioplegia of Histidin-Tryptophan-Ketoglutarat(HTK) was delivered for the protection of donated heart.The removed heart was infused with and stored in 4℃ HTK solution.Result:All patients took off CPB successfully.The CPB time was(110.87±29.83)min,the warm ischemia time was(7.7±1.7)min,and the cold ischemia time was(194.52±121.57)min.Conclusion:Effective donor heart protection,monitoring of blood gas and electrolytes and the ratio of crystal and colloid osmotic pressure to 0.45～0.6 and maintaining mean blood pressure 60～80 mmHg,and application of ultrafiltration and albumin are essential to guarantee the success of heart transplantation.