机械辅助循环作为心脏移植前急诊过渡治疗的临床运用体会

目的 探讨机械辅助循环(MCS)急诊过渡治疗在心脏移植前的患者的应用.方法 回顾分析2005年2月至2007年8月间接受心脏移植前MCS急诊过渡治疗的10例患者的临床资料.其中男性7例,女性3例,平均年龄(40.0±16.2)岁,平均体重(70.8±18.1)kg.全组扩张型心肌病5例,致心律失常性右心室心肌病2例,缺血性心肌病2例,终末期瓣膜病1例.所有患者就诊时均合并急性充血性心力衰竭,药物保守治疗无效.遂急诊行MCS.8例实施体外膜氧合作用进行支持治疗,BVS5000左心室辅助和MEDOS左心室辅助各1例.结果 全组患者接受辅助治疗时间3～44 d,平均(11.5±13.9)d.4例患者成功过渡至行心脏移植,其中1例同期进行了肾移植.2例患者经MCS辅助后心功能好转,撤离MCS后等待心脏移植.2例患者因合并感染,放弃治疗,提前中止辅助;1例在辅助44 d后仍未获得供心,死于脑梗死;1例在辅助过程中死于多脏器功能衰竭.结论 对于合并急性心源性休克的移植前患者,应在患者出现多脏器损害前积极采用MCS急诊过渡治疗,并在辅助过程仔细甄别心功能状况,及时调整治疗策略,以提高救治成功率.

Mechanical circulation support as emergency bridging for heart transplantation

Objective To investigate the experience of patients in acute cardiogenie shock required insertion of mechanical circulation support devices (MCS) before undergoing standard pretransplant evaluations. Methods From February 2005 to August 2007, 10 patients including7 male and 3 female required emergency bridging placement of MCS. Average age was (40±16. 2) years old. Mean body weight was (70. 8±18.1 ) kg. There were 5 patients of dilated cardiomyopathy, 2 patients of arrhythmic right ventricular cardiomyopathy, 2 patients of ischemie eardiomyopathy and 1 patient of end-stage valvular heart disease. All patients were companied with acute decompensation of congestive heart failure. Before implantation of MCS, all patients received treatment of three or more inotropic drugs at maximal dosages, 6 patients suffered from ventricular tachycardia, 4 patients required cardio-pulmonary resuscitation treatment and 3 patients suffered from definite function defect of liver and kidney. MCS included ECMO for 8 patients,BVS5000 and MEDOS for 1 patient respectively. Results The duration of MCS supporting was 3 to 44 d with a mean of ( 11.5 ± 13. 9) d. Four patients were successfully supported for getting heart transplantation,1 patient received kidney transplantation simultaneously. Two patients recovered from acute heart failure,discharged and remained on regular heart transplantation list. One patient died from cerebral embolism after 44 days' support and 1 died from multiple organ failure after 3 days' support. Because of severe infection,MCS treatment of 2 patients was terminated ahead of schedule by their family and the patients were lost finally. Conclusions The use of MCS devices for acute catastrophic situation appears warranted despite the abbreviated transplant evaluations. It is important for improving the outcomes with beginning MCS support before multiple organ system failure occurs, and accurately identifying individuals who can benefit from MCS.