右心辅助在心脏移植术后急性右心衰竭中的临床应用_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

吴敏 , 麦明杰 , 吴怡锦 , 周成斌 , 章晓华 , 林中林 , 郭海江 , 黄劲松

广东省心血管病研究所广东省人民医院广东省医学科学院心外科广东省华南结构性心脏病重点实验室（广州 510080）;

Corresponding author：

吴敏, Email:

Keywords：

心脏移植; 右心辅助; 肺动脉高压; 右心衰竭; 体外膜肺氧合

DOI：

10.7507/1007-4848.201802040

Video：

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目的探讨右心辅助方式治疗合并重度肺动脉高压患者心脏移植术后急性右心衰竭的初步经验。方法回顾性分析 2017 年 4～8 月我院行右心辅助 4 例患者的临床资料，其中男 3 例、女 1 例，平均年龄（46.2±1.8）岁。术前行右心导管监测肺动脉阻力为（7.80±0.67）Wood 单位，肺动脉收缩压（69.75±3.47）mm Hg。在心脏复跳后体外循环并行循环时行肺动脉和股静脉插管，建立右心室辅助并撤离体外循环。辅助至右心功能恢复满意，逐步减低流量，撤除右心辅助。结果 4 例患者全部成功撤除右心辅助并存活。平均供心冷缺血时间为（235.0±18.8）min，体外循环时间为（272.0±41.1）min，并行辅助循环时间为（166.0±32.7）min，平均右心辅助时间为（157.7±27.5）h，全血激活凝固时间（ACT）监测波动于 120～150 s 之间。期间无再次开胸止血事件，无辅助机械障碍发生，无管道内凝血事件发生。结论右心辅助比体外膜肺氧合具有机械故障少，辅助时间长，抗凝要求低，出血少，血细胞、血小板和凝血因子破坏少的优点，而且经济效益可观，更加接近生理循环，不会增加左心后负荷。

Citation： 吴敏, 麦明杰, 吴怡锦, 周成斌, 章晓华, 林中林, 郭海江, 黄劲松. 右心辅助在心脏移植术后急性右心衰竭中的临床应用. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(10): 906-909. doi: 10.7507/1007-4848.201802040 Copy

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10.	李平, 董念国, 赵阳, 等. 体外膜肺氧合在心脏移植围术期的支持策略. 中国体外循环杂志, 2014, 12(4): 237-240.
11.	Beiras-Fernandez A, Deutsch MA, Kainzinger S, et al. Extracorporeal membrane oxygenation in 108 patients with low cardiac output-a single-center experience. Int J Artif Organs, 2011, 34(4): 365-373.
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1. Guazzi M, Naeije R. Pulmonary hypertension in heart failure: pathophysiology, pathobiology, and emerging clinical perspectives. J Am Coll Cardiol, 2017, 69(13): 1718-1734.
2. Fayyaz AU, Edwards WD, Maleszewski JJ, et al. Global pulmonary vascular remodeling in pulmonary hypertension associated with heart failure and preserved or reduced ejection fraction. Circulation, 2018, 137(17): 1796-1810.
3. Mehra MR, Canter CE, Hannan MM, et al. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update. J Heart Lung Transplant, 2016, 35(1): 1-23.
4. Delgado JF, Conde E, Sánchez V, et al. Pulmonary vascular remodeling in pulmonary hypertension due to chronic heart failure. Eur J Heart Fail, 2005, 7(6): 1011-1016.
5. Kumarasinghe G, Jain P, Jabbour A, et al. Comparison of continuous-flow ventricular assist device therapy with intensive medical therapy in fixed pulmonary hypertension secondary to advanced left heart failure. ESC Heart Fail, 2018, 5(4): 695-702.
6. 廖中凯, 王巍, 宋云虎, 等, 心脏移植患者术前肺动脉压力与术后并发症的关系及防治. 中国胸心血管外科临床杂志, 2009, 16(5): 348-352.
7. Hosenpud JD, Bennett LE, Keck BM, et al. The Registry of the International Society for Heart and Lung Transplantation: seventeenth official report-2000. J Heart Lung Transplant, 2000, 19(10): 909-931.
8. Mehra MR, Kobashigawa J, Starling R, et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates--2006. J Heart Lung Transplant, 2006, 25(9): 1024-1042.
9. Chang PP, Longenecker JC, Wang NY, et al. Mild vs severe pulmonary hypertension before heart transplantation: different effects on posttransplantation pulmonary hypertension and mortality. J Heart Lung Transplant, 2005, 24(8): 998-1007.
10. 李平, 董念国, 赵阳, 等. 体外膜肺氧合在心脏移植围术期的支持策略. 中国体外循环杂志, 2014, 12(4): 237-240.
11. Beiras-Fernandez A, Deutsch MA, Kainzinger S, et al. Extracorporeal membrane oxygenation in 108 patients with low cardiac output-a single-center experience. Int J Artif Organs, 2011, 34(4): 365-373.
12. D’Alessandro C, Aubert S, Golmard JL, et al. Extra-corporeal membrane oxygenation temporary support for early graft failure after cardiac transplantation. Eur J Cardiothorac Surg, 2010, 37(2): 343-349.

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右心辅助在心脏移植术后急性右心衰竭中的临床应用

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