中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2014年
6期
329-332
,共4页
孙永丰%董念国%刘金平%蔡杰
孫永豐%董唸國%劉金平%蔡傑
손영봉%동념국%류금평%채걸
心脏移植%冷缺血时间%移植物存活
心髒移植%冷缺血時間%移植物存活
심장이식%랭결혈시간%이식물존활
Heart transplantation%Cold ischemic time%Graft survival
目的 探讨供心冷缺血时间对临床心脏移植术后受者存活的影响,为规范管理临床心脏移植中供者心脏冷缺血时间提供参考.方法 收集2008年9月至2014年3月在单中心进行原位心脏移植的131例受者的临床资料,并进行回顾性统计学分析.供心冷缺血时间为(245.2±120.4)min(103～485)min,其间使用冷组氨酸-色氨酸-酮戊二酸盐液(HTK液)进行保存.根据供心冷缺血时间将病例分为冷缺血时间＜3 h组(62例)、3～6 h组(41例)和＞6 h组(28例).结果 供心冷缺血时间延长可致围手术期主动脉内球囊反搏(IABP)支持率及排斥反应发生率增加,术后冷缺血时间＜3 h组、3～6 h组和＞6 h组IABP支持率分别为3.2％、9.8％和14.3％(P=0.155),排斥反应的发生率分别为6.4％、9.8％和17.9％(P=0.245),但差异均无统计学意义.术后3周各组射血分数均在正常范围之内,3组射血分数的差异无统计学意义(P＜0.05).受者围手术期总体存活率为97.7％(128/131),3组受者围手术期存活率分别为97.3％(72/74)、100.0％(30/30)和96.3％(26/27),差异无统计学意义(P=0.61).术后1年受者总体存活率为89.9％(71/79,其中52例术后随访时间未满1年),3组存活率分别为92.2％(47/51)、90.9％(10/11)和82.4％(14/17),差异无统计学意义(P＞0.05).结论 供心冷缺血时间在6～8 h以内均为临床供者心脏移植的安全时间,可以保证临床心脏移植术近、中期的疗效.冷缺血时间超过6h的扩大标准供者供心虽然受者范围扩大,但为保证移植手术安全性,更应选择适合的受者.冷缺血时间对临床心脏移植远期疗效的影响仍需要进一步观察.
目的 探討供心冷缺血時間對臨床心髒移植術後受者存活的影響,為規範管理臨床心髒移植中供者心髒冷缺血時間提供參攷.方法 收集2008年9月至2014年3月在單中心進行原位心髒移植的131例受者的臨床資料,併進行迴顧性統計學分析.供心冷缺血時間為(245.2±120.4)min(103～485)min,其間使用冷組氨痠-色氨痠-酮戊二痠鹽液(HTK液)進行保存.根據供心冷缺血時間將病例分為冷缺血時間＜3 h組(62例)、3～6 h組(41例)和＞6 h組(28例).結果 供心冷缺血時間延長可緻圍手術期主動脈內毬囊反搏(IABP)支持率及排斥反應髮生率增加,術後冷缺血時間＜3 h組、3～6 h組和＞6 h組IABP支持率分彆為3.2％、9.8％和14.3％(P=0.155),排斥反應的髮生率分彆為6.4％、9.8％和17.9％(P=0.245),但差異均無統計學意義.術後3週各組射血分數均在正常範圍之內,3組射血分數的差異無統計學意義(P＜0.05).受者圍手術期總體存活率為97.7％(128/131),3組受者圍手術期存活率分彆為97.3％(72/74)、100.0％(30/30)和96.3％(26/27),差異無統計學意義(P=0.61).術後1年受者總體存活率為89.9％(71/79,其中52例術後隨訪時間未滿1年),3組存活率分彆為92.2％(47/51)、90.9％(10/11)和82.4％(14/17),差異無統計學意義(P＞0.05).結論 供心冷缺血時間在6～8 h以內均為臨床供者心髒移植的安全時間,可以保證臨床心髒移植術近、中期的療效.冷缺血時間超過6h的擴大標準供者供心雖然受者範圍擴大,但為保證移植手術安全性,更應選擇適閤的受者.冷缺血時間對臨床心髒移植遠期療效的影響仍需要進一步觀察.
목적 탐토공심랭결혈시간대림상심장이식술후수자존활적영향,위규범관리림상심장이식중공자심장랭결혈시간제공삼고.방법 수집2008년9월지2014년3월재단중심진행원위심장이식적131례수자적림상자료,병진행회고성통계학분석.공심랭결혈시간위(245.2±120.4)min(103～485)min,기간사용랭조안산-색안산-동무이산염액(HTK액)진행보존.근거공심랭결혈시간장병례분위랭결혈시간＜3 h조(62례)、3～6 h조(41례)화＞6 h조(28례).결과 공심랭결혈시간연장가치위수술기주동맥내구낭반박(IABP)지지솔급배척반응발생솔증가,술후랭결혈시간＜3 h조、3～6 h조화＞6 h조IABP지지솔분별위3.2％、9.8％화14.3％(P=0.155),배척반응적발생솔분별위6.4％、9.8％화17.9％(P=0.245),단차이균무통계학의의.술후3주각조사혈분수균재정상범위지내,3조사혈분수적차이무통계학의의(P＜0.05).수자위수술기총체존활솔위97.7％(128/131),3조수자위수술기존활솔분별위97.3％(72/74)、100.0％(30/30)화96.3％(26/27),차이무통계학의의(P=0.61).술후1년수자총체존활솔위89.9％(71/79,기중52례술후수방시간미만1년),3조존활솔분별위92.2％(47/51)、90.9％(10/11)화82.4％(14/17),차이무통계학의의(P＞0.05).결론 공심랭결혈시간재6～8 h이내균위림상공자심장이식적안전시간,가이보증림상심장이식술근、중기적료효.랭결혈시간초과6h적확대표준공자공심수연수자범위확대,단위보증이식수술안전성,경응선택괄합적수자.랭결혈시간대림상심장이식원기료효적영향잉수요진일보관찰.
Objective Given the significant differences of ischemia-time tolerance observed in clinical heart transplantation between heart and other solid organs,it is important to make a clinical assessment of the correlation between the cold ischemic time of the donor heart and the survival rate after heart transplantation.With these results,we may standardize the management of clinical heart transplantation by providing a proper heart cold ischemic time frame for reference.Method The clinical data of 131 orthotopic heart transplantation patients in our hospital,from September 2008 to March 2014,were collected and analyzed retrospectively.All donor hearts were preserved in histidinetryptophan-ketoglutarate solution (HTK solution) during cold ischemic time.The cold ischemia time was 103-485 min,with an average of 245.2 ± 120.4 min.According to the cold ischemic time,all patients were divided into three groups:＜ 3 h (n =62); 3-6 h (n =41); ＞6 h (n =28).Result (1) Prolonged cold ischemia time could result in high IABP usage perioperatively (postoperative IABP support rate for the three groups was 3.2％,9.8％ and 14.3％ respectively,P =0.155) and high rejection rate (incidence of rejection was 6.4％,9.8％ and 17.9％ respectively,P =0.245),but there was no statistically significant difference.(2) Three weeks after the transplantation,all EF values of the three groups were reduced within the normal range,with no significant difference.Perioperative overall survival rate was 97.7％ (128/131),while survival rate of the three groups was 97.29％ (72/74),100％ (30/30) and 96.29％ (26/27),respectively (P =0.61).(3) One-year overall survival rate was 89.87％ (71/79),and the one-year survival rate of three groups was 92.2％ (47/51),90.9％ (10/11) and 82.4％ (14/17) respectively (P=0.51).Fifty-two patients were still under 1 year follow-up period.This study aimed to illustrate the effect of different cold ischemic time on perioperative cardiac function,rejection rate,IABP usage postoperatively (intra-aortic balloon pump or intra-aortic balloon counterppulsation) and early/mid-term efficacy after transplantation.Conclusion Cold ischemic time within 6-8 h is clinically safe for heart transplantation,and can provide satisfactory early and medium-term effect.Donor heart with cold ischemia time longer than 6 h may extend the recipient inclusion criteria.But considering the safety of transplantation,these donor hearts may be more applicable for the marginal recipients.This study describes the relationship between cold ischemic time and early and medium-term effect of heart transplantation.However,its long-term effects still require further investigation.
