同种异体原位心脏移植术后急性右心衰竭治疗

Treatment for acute right heart failure at early stage of cardiac transplantation

关键词:  原位心脏移植  心肌病  急性右心衰竭

Key words:  orthotopic cardiac transplantation  cardiomyopathy  acute right heart failure

摘要:

［目的］ 探讨心脏移植术后早期右心衰竭的治疗措施。［方法］ 选择1例终末期扩张型心肌病人实施同种异体原位心脏移植手术。术前受者超声心动图估测肺动脉压力（PAP），术中、术后Swan-Ganz导管监测肺动脉压力、中心静脉压、连续心排量（PAP、CVP、CCO）。［结果］ 术后30 h出现典型右心衰竭表现（症状、体征及压力监测），积极综合治疗心衰纠正。［结论］ 选择合适的供、受体，完善的术前准备，精确的术式，连续、动态的围手术期监测和积极的综合治疗是心脏移植术后急性右心衰竭治疗成败的关键。

Abstract:

［Objective］To evaluate a treatment for the acute right heart failure at the early stage of cardiac transplantation.［Method］ Select one orthopic cardiac transplantation performed on a patient with end stage cardiomyopathy. Colour Doppler evaluate pulmonary artery pressure(PAP) preoperation and monitor pulmonary artery pressure(PAP),central venous pressure (CVP),continuous cardiac output(CCO) with Swan-Ganz at intraoperation and postoperation. ［Results］ Topic acute right heart failure occurred at the 30 hours after operation (Symptom , physical sign and pressure monitoriy),go through it after synthetical treatment actively. ［Conclusion］Key to treatment of acute right heart failure consists of suitable donor and receptor , perfect preoperative preparation , accurate surgery approach , dynamic perioperative monitor and synthetical treatment.