CAJ | 학술논문

目的观察心脏移植患者术前肺动脉高压对术后早期并发症及存活的影响.方法分析76例心脏移植患者住院资料.根据术前肺动脉收缩压(sPAP)是否≥45 mmHg(1 mmHg=0 133 kPa)分为肺动脉高压组(n=22)和对照组(n=54).分析比较两组受者术前一般资料、术后并发症发生率及术后早期存活率.结果肺动脉高压组与对照组受者术前sPAP分别为(52.0±4.6) mmHg和(28.0±5.2) mmHg,两组患者术前的吸烟史百分率、原发病中心肌病百分率、氨基末端B型利钠肽前体(NT-proBNP)、中心静脉压(CVP)和移植前心力衰竭时间的差异有统计学意义(P＜0.05).两组术后机械通气时间、右心衰竭发生率、二次插管/气管切开率、需持续肾脏替代治疗(CRRT)或体外膜肺氧合(ECMO)支持治疗应用率以及ICU住院时间的差异也有统计学意义(P＜0.05).两组术后早期存活率分别为95.5％和96.3％,差异无统计学意义(P＞0.05).结论术前肺动脉高压的心脏移植患者术后并发症发生率高于对照组,经有效降低肺动脉高压治疗后术后早期存活率未受影响.
목적 관찰심장이식환자술전폐동맥고압대술후조기병발증급존활적영향.방법 분석76례심장이식환자주원자료.근거술전폐동맥수축압(sPAP)시부≥45 mmHg(1 mmHg=0 133 kPa)분위폐동맥고압조(n=22)화대조조(n=54).분석비교량조수자술전일반자료、술후병발증발생솔급술후조기존활솔.결과 폐동맥고압조여대조조수자술전sPAP분별위(52.0±4.6) mmHg화(28.0±5.2) mmHg,량조환자술전적흡연사백분솔、원발병중심기병백분솔、안기말단B형리납태전체(NT-proBNP)、중심정맥압(CVP)화이식전심력쇠갈시간적차이유통계학의의(P＜0.05).량조술후궤계통기시간、우심쇠갈발생솔、이차삽관/기관절개솔、수지속신장체대치료(CRRT)혹체외막폐양합(ECMO)지지치료응용솔이급ICU주원시간적차이야유통계학의의(P＜0.05).량조술후조기존활솔분별위95.5％화96.3％,차이무통계학의의(P＞0.05).결론 술전폐동맥고압적심장이식환자술후병발증발생솔고우대조조,경유효강저폐동맥고압치료후술후조기존활솔미수영향.
Objective To determine the influence of preoperative pulmonary hypertension on the early complications and survival after heart transplantation.Methods Seventy-six patients receiving heart transplantation were divided into two groups according to preoperative pulmonary arterial systolic pressure (sPAP):pulmonary hypertension group (n=22),preoperative sPAP ≥ 45 mmHg (i mmHg=0.133 kPa);control group (n =54),preoperative sPAP ＜45 mmHg.Clinical characteristic data,postoperative recovery data and early survival of two groups were compared.Results sPAP in pulmonary hypertension group was significantly higher than that in control group [(52.0 ± 4.6) mmHg vs.(28.0 ± 5.2 mmHg),P ＜ 0.05].Preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP),central venous pressure (CVP),length of heart failure,incidence of smoking and cardiomyopathy in pulmonary hypertension group were significantly higher than those in control group (P ＜ 0.05).Postoperative duration of mechanical ventilation,ICU length of stay,incidence of right heart failure,tracheotomy and complications required continuous renal replacement therapy (CRRT)/extracorporeal membrane oxygenation (ECMO) support had statistically significant difference between two groups (P ＜ 0.05).There was no statistically significant difference in the early postoperative survival between two groups (P ＞ 0.05).Conclusion The early postoperative complications were related to preoperative pulmonary hypertension in heart transplant patients.The early postoperative survival was not affected by effectively controlling pulmonary hypertension.