摘要
目的分析原位心脏移植术后早期血流动力学变化,以指导临床治疗.方法为17例扩张性心肌病、4例心力衰竭、3例克山病和1例冠状动脉搭桥术后患者施行原位心脏移植术,术后应用Swan-Ganz导管和彩色多普勒B型超声波对血流动力学指标进行监测,然后结合监测指标及临床表现,对治疗方案进行相应调整.结果术后当天,肺毛细血管楔压(PAWP)、肺动脉收缩压(PASP)、中心静脉压(CVP)降低,心排血量(CO)、心排血指数(CI)增加;术后1～7 d,PAWP、PASP、CVP升高,右心室呈进行性增大,伴发心律失常、胸腔积液等,给予强心、利尿、扩血管治疗,23例血流动力学状况逐步好转,恢复稳定;2例无明显好转,分别于术后16、23 d死于多器官功能衰竭.结论心脏移植术后血流动力学变化多发生在早期,主要为右心功能不全所致;及时监测血流动力学变化并分析其原因,可以正确指导临床治疗,对病情恢复及愈后起着重要作用.
Objective To review the clinical changes and the management experience of hemodynamics after orthotopic heart transplantation. Methods Orthotopic homologous heart transplantation was performed on 25 cases from January 2000 to October 2003. The hemodynamic changes were monitored after operation with Swan-Ganz catheter and color Dopplor ultrasound. The therapy strategy was regulated when the monitor index and the clinical situation were referenced. Results PAWP, PASP, CVP, CO and CI were increased on the operation day. From the first day to the 7th day, PAWP, PASP and CVP were increased with right ventricle enlarged and sometimes arrhythmia and hydrothorax occurred. After strengthening heart, diuresis and stretching vessel, the hemodynamic changes of 23 cases were inversed and two cases＇ conditions got worse. The two patients died of multiple organ failure on the 16th and 23rd day respectively. Conclusion The hemodynamic changes often occur at the early term after orthotopic heart transplantation. The main change is the right ventricular failure. It is important for the patient＇s condition recovery and prognosis to monitor the hemodynamic changes and analyze the cause in order to direct the therapy.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2005年第9期558-560,共3页
Chinese Journal of Organ Transplantation
