原位心脏移植的体外循环管理

Management of cardiopulmonary bypass on orthotopic heart tansplantation

关键词:  心脏移植  体外循环  心肌保护

Key words:  heart transplantation  cardiopulmonary bypass  myocardial protection

摘要:

［目的］探讨原位心脏移植体外循环管理经验。［方法］ 通过对低温体外循环下同种异体原位心脏移植患者的临床资料分析，总结心肌保护及体外循环的注意事项。［结果］供心热缺血3 min，冷缺血129 min，转机135 min，后并行54 min，受体主动脉阻断64 min，自动复跳，供心术后心脏超声显示心脏结构正常，安全度过围术期，出院至今情况稳定。［结论］ 良好的供心心肌保护，合理的体外循环管理，内环境调整和多项监测指标正常范围是移植成功的关键因素。

Abstract:

［Objective］ To summarize the experience for cardiopulmonary bypass (CPB) of orthotopic heart transplantation. ［Methods］ By analysing clinical material of a patient suffering orthotopic heart transplantation under hypothermic cardiopulmonary bypass, summarize the points for attention to myocardial protection and CPB. ［Results］Donor heart warm ischemia 3 minutes,cold ischemia 129 minutes,CPB 135 minutes including assistted circulation time 54 minutes and 64 minutes for aorta clamping. The heart recover automatically after aorta declamping.the ultrasound pattern of the heart after operation is normal.［Conclusion］ Excellent myocardial protection of donor heart, reasonable management for CPB, proper interenal environment and various moniter indexes are key factors to successful heart transplantation.