心脏移植围术期右心功能不全与肺血管阻力的关系及处理

doi:10.6040/j.issn.1671-7554.0.2019.069

摘要/Abstract

摘要： 目的探讨低排出量心力衰竭行心脏移植患者心脏移植围术期右心功能不全与肺血管阻力的相关性及临床处理措施。方法回顾性分析2008年至2018年期间于山东大学附属千佛山医院因终末期心力衰竭接受原位心脏移植治疗患者42例,其中男34例,女8例,20~68岁,平均(49.55±11.58)岁。术前常规行漂浮导管检查,根据肺血管阻力的大小将患者分为高肺血管阻力组(肺血管阻力≥3.5 Wood单位,n=24例)和低肺血管阻力组(肺血管阻力<3.5 Wood单位,n=18)。收集术前左心室大小和左室射血分数;漂浮导管所测得心排出量、肺动脉压及肺动脉楔压;供体缺血时间、术中体外循环时间等。术后心脏超声监测和评价术后3、15 d右心室大小、三尖瓣返流程度等。结果两组性别、年龄、体质量、术前左室大小、射血分数等基线特征基本一致,差异无统计学意义(P>0.05)。两组术前肺动脉压力分别为(47.79±7.78)mmHg和(38.78±5.48)mmHg,差异有统计学意义(P<0.05)。肺动脉楔压分别为(29.25±7.75)mmHg和(28.33±6.22)mmHg,差异无统计学意义(P>0.05)。术前心排出量分别为(2.96±1.24)L/min和(5.16±1.52)L/min,差异有统计学意义(P<0.05)。高肺血管阻力组和低肺血管阻力组术中体外循环时间分别为(256.25±88.79)min和(181.11±52.59)min,并行时间分别为(147.71±84.84)min和(89.00±32.78)min,差异有统计学意义(P<0.05)。术后3 d行心脏彩超示高肺血管阻力组右室直径［(25.96±3.76)mm］与低肺血管阻力组相比［(22.00±4.70)mm］增大,且三尖瓣返流中度及以上程度的高于低肺血管阻力组,差异有统计学意义(P<0.05)。结论心脏移植术后早期发生严重右心功能不全与肺血管阻力增高呈正相关,肺血管阻力增高患者在心脏移植过程中需要更长的并行循环时间保证供心功能的恢复。

关键词: 心脏移植, 肺血管阻力, 右心功能不全, 体外循环时间

Abstract: Objective To investigate the relationship between right ventricular insufficiency and pulmonary vascular resistance in patients with low-output heart failure during the perioperative period and the clinical management experience. Methods The clinical data of 42 patients with end-stage heart failure undergoing orthotopic heart transplantation at 山东大学学报 (医学版)57卷5期 -车东阳,等.心脏移植围术期右心功能不全与肺血管阻力的关系及处理 \=-Qianfoshan Hospital Affiliated to Shandong University during 2008 and 2018 were retrospectively analyzed, including 34 males and 8 females. The patients aged 20 to 68 years, average(49.55 ±11.58)years. According to the results of routine floating catheter examination, the patients were divided into two groups: high pulmonary vascular resistance group(PVR≥3.5 Wood, n=24)and low pulmonary vascular resistance group(PVR<3.5 Wood, n=18). The left ventricular size, left ventricular ejection fraction, cardiac output, pulmonary artery pressure, pulmonary wedge pressure, donor ischemia time, and intraoperative cardiopulmonary bypass time were recorded. Postoperative echocardiography was performed to evaluate the right ventricular size and tricuspid regurgitation on day 3 and 15. Results There were no statistical differences in the baseline data between the two groups, including gender, age, weight, preoperative left ventricular size, and ejection fraction (P>0.05). The preoperative pulmonary artery pressure was(47.79±7.78) vs(38.78±5.48)mmHg in the high pulmonary vascular resistance group and low pulmonary vascular resistance group, and the difference was statistically significant (P<0.05). The preoperative pulmonary artery wedge pressure was(29.25±7.75)vs(28.33±6.22)mmHg (P>0.05). The preoperative cardiac output was(2.96±1.24)vs(5.16±1.52)L/min (P<0.05). The intracardiac circulation time was(256.25±88.79)vs(181.11±52.59)min, and the parallel time was(147.71±84.84)vs(89.00±32.78)min(both P<0.05). On day 3 after operation, echocardiography showed that the diameter of right ventricle was(25.96±3.76)vs(22.00±4.70)mm (P<0.05), and the mean value of tricuspid regurgitation was higher in the high low pulmonary vascular resistance group than in the low pulmonary vascular resistance group (P<0.05). Conclusion There is a positive correlation between severe right ventricular insufficiency after heart transplantation and increased pulmonary vascular resistance. Patients with high pulmonary vascular resistance need longer bypass time to ensure the recovery of donor cardiac function.

Key words: Heart transplantation, Pulmonary vascular resistance, Right ventricular insufficiency, Cardiopulmonary bypass time

中图分类号:

R617

车东阳,厉泉,陈善良,于建民,李敏,许莉,毕严斌,李培杰,刘天起. 心脏移植围术期右心功能不全与肺血管阻力的关系及处理[J]. 山东大学学报 (医学版), 2019, 57(5): 99-104.

CHE Dongyang, LI Quan, CHEN Shanliang, YU Jianmin, LI Min, XU Li, BI Yanbin, LI Peijie, LIU Tianqi. Relationship between right cardiac insufficiency and pulmonary vascular resistance in the perioperative period of cardiac transplantation and management[J]. Journal of Shandong University (Health Sciences), 2019, 57(5): 99-104.

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