边缘性供心移植术中采用体外膜肺氧合技术四例

目的 研究体外膜肺氧合(ECMO)技术用于边缘性供心移植的临床效果.方法 4例患者心脏移植时采用ECMO技术,其供心的冷缺血时间长达4.8～8.0 h.术中采用ECMO技术代替体外循环,全流量控制在4.5～5.0 L/min,术后流量降到1/2左右时,改为经典的ECMO心脏辅助管路的连接方式,带ECMO辅助回到重症监护室,随后在合适的时机撤除ECMO的辅助.结果 4例手术均顺利完成,主动脉开放后心脏自动复跳.术中阻断时间为(90±3)min,转机(136±14)min,转流时的主动脉流量为50～70 ml·kg-1·min-1,氧流量为2～4 L/min.4例患者均于术后第2天撤除ECMO,术后ECMO辅助时间为(16±4)h.2例术后出现出血,1例右下肢出现淋巴漏和神经过敏,经过积极治疗后好转,无右心衰竭和三尖瓣明显返流现象.4例患者恢复顺利,出院时左心室舒张末径为37～43 mm,左心室射血分数为56 %～64 %,三尖瓣无返流或仅有轻度返流,心功能均为Ⅱ级.结论 以ECMO代替体外循环技术可以有效地保护供心,有利于经历长时间缺血的供心恢复功能.

Perioperative extracorporeal membrane oxygenation technique for the marginal donor heart transplantation: a report of 4 cases

Objective To investigate the clinical results of the perioperative extracorporeal membrane oxygenation(ECMO)technique instead of conservative CPB used in the heart transplantation operation with long ischemic time donor hearts.Methods In 2006 the ECMO technique instead of conservative CPB was tried in the heart transplantation in 4 cases of long ischemic time donor hearts with ischemic time arranging from 4.8 to 8.0 h.During the operation the pump blood flow rate was controlled at 4.5-5.0 L/min. The conservative ECMO canula connection was retained after the assisted blood flow was reduced to one half after the operation.Then the patients returned back to ICU with the ECMO assistance and the ECMO was removed in the following suitable time.Results Totally 4 cases of heart transplantation were performed with the ECMO techniques instead of the CPB.All the hearts rebeated automatically after the successful operation.The mean cross clamp time was(90±3)min with on pump(136±14)min.The femoral artery blood flow rate during the ECMO machines were removed the next day.All the recipients recovered without right ventricular failure or obvious tricuspid regurgitation which were commonly seen after heart transplantation Postoperative bleeding occurred in 2 cases and lymphoid leakage and leg nerve overreact phenomenon in 1 case respectively.All the 4 cases discharged with NYHA Ⅰ/Ⅱcardiac function without tricuspid regurgitation.The mean left ventricle end-diastolic dimension was 37-43 mm and the left ventricle ejection fraction arranged from 56% to 64 %.Conclusion Replacing the routine CPB with ECMO techniques in the heart transplantation could effectively protect the donor hearts even with long cold ischemic time and improve the cardiac function recovery.