原位心移植术体外循环管理

目的:总结4例原位心脏移植术体外循环(extracorporeal circulation,ECC)经验.方法:4例均采用中低温,中、高流量灌注.术中注重心、肺、肾等重要器官及血液的保护.切取供心前灌注4℃改良St.Thomas液使其迅速停搏.供心离体后,用5 000 mL冷生理盐水冲洗心腔后经主动脉根部灌注4℃威斯康星大学溶液(University of Wisconsin solution,UW液)1 000 mL,放入冰生理盐水内保存.吻合全程中供心表面置冰屑,左心房内滴注冷生理盐水.结果:ECC时间(133.3±13.1)min,供心热缺血时间为1～3 min,冷缺血时间为(142.0±28.2)min.4例心脏均自动复跳,术后1月左室射血分数为60%～65%.1例因急性排异反应术后第150天猝死,其余3例目前存活.结论:良好的ECC管理,注重各重要器官功能及供心心肌保护是心脏移植手术成功的重要因素.

Cardiopulmonary bypass of orthotopic heart transplatation

OBJECTIVE: To summarize the extracorporeal circulation(ECC) management experiences on 4 cases of orthotopic heart transplantation. METHODS: All patients received moderate hypothermia and high flow rate perfusion. Many strategies were taken to maximize the protection of myocardium, lung, kidney and blood conservation. The donor hearts were arrested with aorto perfusion using modified St.Thomas solution at 4 degrees C. After being flushed with 5,000 mL cold saline, the donor hearts were perfused with 1,000 mL UW solution in 4 degrees C and preserved in ice saline. Ice mud was covered on the donor heart and cold saline was dripped into left atrium in the period of anastomosis. RESULTS: The ECC time was 133.3+/-13.1 min, and the warm and cold ischemia time was respectively 1-3 min and 142.0+/-28.2 min. All the cases recovered heart beats automatically. Left ventricular ejection fractions were 60%-65% a month postoperatively. One patient died of acute rejection 150 days postoperatively. 3 cases survived. CONCLUSION: Proper ECC management, importment organs and donor heart protection are the key to success in heart transplant operations.