CAJ | 학술논문

目的回顾性分析将体外膜肺氧合(ECMO)代体外循环技术应用于长时间冷缺血供体进行心脏移植手术的临床效果,探讨扩大边缘性供心的适用范围.方法 2006年至2011年期间,12例心脏移植术前预计冷缺血时间大于4～6h的患者,术中采取ECMO代体外循环技术.患者年龄29 ～ 54岁,术前均诊断为扩张性心肌病;供体年龄28 ～44岁.术后流量降至一半时改为经典ECMO心脏辅助管路连接方式,患者带持续辅助的ECMO返监护室,选择合适时机撤除ECMO.结果 12例心脏移植患者手术均成功,主动脉开放后心脏均自动复跳.供体冷缺血5.8～10.0 h,平均(7.2±2.4)h;主动脉阻断84.0～94.0 min,平均(90.0±3.0) min;体外循环127.0 ～ 150.0 min,平均(136.0 ±14.0) min.术后第2天4例患者顺利撤除ECMO辅助,所有患者住监护室ECMO辅助时间18.0 ～98.0 h,平均(71.0±4.0)h.术后2例出现出血并发症,1例右下肢淋巴漏和神经过敏,均经积极治疗好转.患者均顺利出院,超声心动图示左心室舒张末径37.0 ～ 43.0 mm,左心室射血分数为0.56 ～0.60.结论 ECMO代体外循环技术可更好地保护供体心脏,利于长时间缺血供心的功能恢复和科学地扩大边缘性供体心脏的使用范围,使得心脏移植手术获得更好临床效果,值得推广应用.
목적 회고성분석장체외막폐양합(ECMO)대체외순배기술응용우장시간랭결혈공체진행심장이식수술적림상효과,탐토확대변연성공심적괄용범위.방법 2006년지2011년기간,12례심장이식술전예계랭결혈시간대우4～6h적환자,술중채취ECMO대체외순배기술.환자년령29 ～ 54세,술전균진단위확장성심기병;공체년령28 ～44세.술후류량강지일반시개위경전ECMO심장보조관로련접방식,환자대지속보조적ECMO반감호실,선택합괄시궤철제ECMO.결과 12례심장이식환자수술균성공,주동맥개방후심장균자동복도.공체랭결혈5.8～10.0 h,평균(7.2±2.4)h;주동맥조단84.0～94.0 min,평균(90.0±3.0) min;체외순배127.0 ～ 150.0 min,평균(136.0 ±14.0) min.술후제2천4례환자순리철제ECMO보조,소유환자주감호실ECMO보조시간18.0 ～98.0 h,평균(71.0±4.0)h.술후2례출현출혈병발증,1례우하지림파루화신경과민,균경적겁치료호전.환자균순리출원,초성심동도시좌심실서장말경37.0 ～ 43.0 mm,좌심실사혈분수위0.56 ～0.60.결론 ECMO대체외순배기술가경호지보호공체심장,리우장시간결혈공심적공능회복화과학지확대변연성공체심장적사용범위,사득심장이식수술획득경호림상효과,치득추엄응용.
Objective To investigate clinic results of the ECMO technique instead of conservative CPB used in the heart transplantation operation with long ischemic time donor hearts.Methods Between 2006 to 2011,ECMO technique instead of conservative CPB was tried in 12 patients who accepted the heart transplantation operation with long ischemic time donor heart.The conservative ECMO canula connection was retained after the assist blood flow reduced to one half after the operation.Then the patients returned back to ICU with the ECMO assistance,ECMO was removed in the following suitable time.Results The average cold ischemic time of the donor hearts ranged from 5.8 h to 10.0 h,averaged (7.2 ± 2.4) h.The donor ages ranged from 28 to 44 years old.The femoral artery blood flow rate during the operation is 50.0-70.0 ml · kg-1 · min-1,O2 flow rate is 2.0-4.0 L/min,blood/O2 ratio is 1∶ 1.All the hearts rebeated automatically after the successful operation.ECMO were removed after assistance for 18.0-98.0 h,averaged (71.0 ±4.0) h.As to the complications,2 cases were found with bleeding and 1 with lymphoid leakage and leg nerve overreact phenomenon.Conclusion Replacing the CPB with ECMO techniques in the heart transplantation operation could get good myocardial protection results even with long cold ischemic time and improve the cardiac function recovery.This technique could maximize the marginal donor pool with good clinic results and should be expanded to use for the marginal donors.