中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2012年
9期
536-538
,共3页
史嘉玮%董念国%刘金平%张菁%蔡杰%李平%陈剑锋%肖诗亮%郑启昌%熊俊
史嘉瑋%董唸國%劉金平%張菁%蔡傑%李平%陳劍鋒%肖詩亮%鄭啟昌%熊俊
사가위%동념국%류금평%장정%채걸%리평%진검봉%초시량%정계창%웅준
心肝联合移植%围手术期医护
心肝聯閤移植%圍手術期醫護
심간연합이식%위수술기의호
Combined heart-liver transplantation%Perioperative care
目的 总结原位心肝联合移植1例的诊治体会.方法 2011年11月24日施行了1例原位心肝联合移植,患者原发病为先天性三尖瓣下移畸形、三尖瓣置换术后5年,合并淤血性肝硬化,术前心功能Ⅳ级,肝功能Child Pugh评分为B级.手术采用分次体外循环辅助的方式,先建立腔静脉主动脉转流完成心脏移植,然后建立股静脉-升主动脉转流完成肝移植,最后停机中和.术中主动脉阻断时间为54min,无肝期为38 min,3次体外循环转流时间共计199m in,手术耗时共计517 min.给予巴利昔单抗联合甲泼尼龙免疫诱导治疗,并采用他克莫司+吗替麦考酚酯+泼尼松的方案抗排斥反应,术后加强护肝治疗、抗感染治疗和营养支持治疗.结果 术后第78天受者因多器官功能衰竭而死亡.受者接受呼吸机辅助治疗的时间为78 d,因术后出现低氧血症而接受体外膜肺氧合辅助治疗的时间为63 d.结论 心肝联合移植术是治疗心肝功能衰竭的有效手段,手术前后的管理具有较高要求.
目的 總結原位心肝聯閤移植1例的診治體會.方法 2011年11月24日施行瞭1例原位心肝聯閤移植,患者原髮病為先天性三尖瓣下移畸形、三尖瓣置換術後5年,閤併淤血性肝硬化,術前心功能Ⅳ級,肝功能Child Pugh評分為B級.手術採用分次體外循環輔助的方式,先建立腔靜脈主動脈轉流完成心髒移植,然後建立股靜脈-升主動脈轉流完成肝移植,最後停機中和.術中主動脈阻斷時間為54min,無肝期為38 min,3次體外循環轉流時間共計199m in,手術耗時共計517 min.給予巴利昔單抗聯閤甲潑尼龍免疫誘導治療,併採用他剋莫司+嗎替麥攷酚酯+潑尼鬆的方案抗排斥反應,術後加彊護肝治療、抗感染治療和營養支持治療.結果 術後第78天受者因多器官功能衰竭而死亡.受者接受呼吸機輔助治療的時間為78 d,因術後齣現低氧血癥而接受體外膜肺氧閤輔助治療的時間為63 d.結論 心肝聯閤移植術是治療心肝功能衰竭的有效手段,手術前後的管理具有較高要求.
목적 총결원위심간연합이식1례적진치체회.방법 2011년11월24일시행료1례원위심간연합이식,환자원발병위선천성삼첨판하이기형、삼첨판치환술후5년,합병어혈성간경화,술전심공능Ⅳ급,간공능Child Pugh평분위B급.수술채용분차체외순배보조적방식,선건립강정맥주동맥전류완성심장이식,연후건립고정맥-승주동맥전류완성간이식,최후정궤중화.술중주동맥조단시간위54min,무간기위38 min,3차체외순배전류시간공계199m in,수술모시공계517 min.급여파리석단항연합갑발니룡면역유도치료,병채용타극막사+마체맥고분지+발니송적방안항배척반응,술후가강호간치료、항감염치료화영양지지치료.결과 술후제78천수자인다기관공능쇠갈이사망.수자접수호흡궤보조치료적시간위78 d,인술후출현저양혈증이접수체외막폐양합보조치료적시간위63 d.결론 심간연합이식술시치료심간공능쇠갈적유효수단,수술전후적관리구유교고요구.
Objective To summarize the diagnosis and treatment of one case of combined heart liver transplantation. Methods On November 24, 2011, one case of combined heart-liver transplantation was performed on a patient with Ebstein's anomaly and tricuspid valve replacement after 5 years,complicated with congestive cirrhosis,liver failure dccompensation,preoperative heart failure Ⅲ degree and B grade of liver function Child-Pugh score. The operation was done with the graded cardiopulmonary bypass assisted mode:first creating the vena cava-aortic bypass to complete heart transplantation, second creating the femoral vein-ascending aorta bypass to complete liver transplantation,and third stopping and neutralizing.The aortic cross-clamping time was 54 min and the an hepatic phase was 38 min.The total time of three times of cardiopulmonary bypass was 199 min and the total time-consuming of operation was 517 min. The patient was given basiliximab +methylprednisolone for immune induction therapy, and tacrolimus + mycophenolate mofetil +prednisone solution for anti-rejection. After operation, liver protecting treatment, anti-infection therapy and nutrition support therapy were given.Results The recipient died of multiple organ failure after 78 days.The mechanical ventilation treatment duration for this recipient was 78 days and ECMO adjuvant therapy for postoperative hypoxemia time lasted 63 days.Conclusion The combined heart liver transplantation is an effective measures for treatment of heart and liver failure.
