【摘要】 目的:总结心脏移植围手术期处理的初步经验。方法:2例终末期扩张性心肌病和1例复杂性先心病人进行了同种原位心脏移植术,围手术期分别在受体和供体的选择、供心的保护、循环和呼吸的支持治疗、免疫治疗和监测、预防感染这五方面着重进行了处理。结果:所有病人均存活,心功能由Ⅳ级提升至Ⅰ～Ⅱ级;术前EF平均27.67％,术后提高到69.3％;未发生循环和呼吸系统并发症,亦未发生排异和严重感染等并发症,顺利出院。随访1年多,3例患者均生活质量良好。结论:心脏移植手术的成功除了熟练的手术技术外,选择恰当的供体和受体、良好的供心保护、适当的循环和呼吸的支持治疗、正确的免疫治疗和监测、有效的防感染措施是心脏移植围手术期处理的重点,是确保手术成功的关键。更多还原

【Abstract】 Objective: To sum up the experience of perioperative management of orthotopic cardiac transplantation. Methods : Othotopic heart transplantations were performed on two cases of terminal myocardosis and one case of congenital tricuspid atresia. During intraoperative period, meticulous attention was paid on selection of recipient and donor, protection of donor heart: circulatory and respiratory support: administration of immunosuppressive drugs and monitoring of rejection, prevention of infection. Results: All patients survived and discharged uneventfully. Rejection and infection didnot occur. Heart function improved from NYHA classc! preoperatively to NYHA class `! - a! postoperatively. LVEF improved from 27.67% preopera-tively to 69.30% postoperatively. Following up for one year, all patients had a good quality of life. Conclusion: Appropriate perioperative management including patient selection, donor heart protection, circulation and respiration support, immunosuppressive therapy and monitoring of rejection, prevention of infection are critical for successful heart transplantation.更多还原