9例犬供心超长时间保存后行原位心脏移植体外循环的管理(PDF)
《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]
- 期数:
- 2008年第5期
- 页码:
- 559-562
- 栏目:
- 基础研究
- 出版日期:
- 2008-10-20
文章信息/Info
- Title:
- Management of cardiopulmonary bypass for canine orthotopic heart transplantation after longterm donor heart preservation in 9 dogs
- Author(s):
- XU Lijun; LIN Xingguang; CHEN Zhonghua; HE Wentao; ZHOU Hongmin
- Institute of Organ Transplantation, Key Lab of Ministry of Education/Ministry of Health, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
- 分类号:
- R541;R654.2
- DOI:
- -
- 文献标识码:
- A
- 摘要:
- 目的 总结9例犬供心超长时间保存后行原位心脏移植的体外循环管理经验。方法 供体心脏以冷UW液（3例）或自制保存液（6例）灌注停跳、摘取心脏后保存24 h；在全麻下以标准法或双腔静脉法术式行犬原位心脏植入，体外循环均采用浅低温中流量、中度血液稀释法，以移植心脱离体外循环后，血流动力学稳定（窦性心律、心率≥90次/min、平均动脉压≥90 mmHg,1 mmHg=0.133 kPa） 4 h为手术成功。结果 全组体外循环过程顺利，体外循环总时间(180±30)min，升主动脉阻断时间为(130±20)min，后并行时间(60±10)min，供心热缺血时间0～30 s、冷缺血时间(24±0.5)h。主动脉开放后，3例移植心自动复跳，4例移植心电击复跳，移植心复跳受者手术均成功。死亡2例为实验早期手术操作技巧不当所致。结论 除良好的供心保护外，良好的体外循环管理亦是犬心脏移植成功的关键。
- Abstract:
- AIM To summarize the experience of management of cardiopulmonary bypass (CPB) for canine orthotopic heart transplantation after longterm graft cold preservation in 9 dogs. METHODS The beating of donor hearts were ceased by in situ perfusion with either 1 000 ml of cold UW solution (3 cases) or selfmade solution (6 cases) through aorta, and the hearts were then removed from donors and preserved at 4℃ for 24 h. Under the combined intravenousinhalational general anesthesia, canine orthotopic heart transplantation was performed using a method of either standard or bicaval technique with the aid of CPB, which was conducted with mild hypothermia and moderate flow rate perfusion. The transplant surgery was considered to be successful when the recipient’s hemodynamics was kept well and stable (sinus rhythm, heart rate≥90 bpm, mean artery pressure≥90 mmHg) for 4 h after withdrawal of the CBP. RESULTS The CPB procedures in all cases went smooth with a total time of (180±30)min, the ascending aorta was clamped for (130±20)min, the accessorial circulation time was (60±10)min, the warm ischemic time of grafts ranged from 0 to 30 seconds and the cold ischemic time was (24±05)h. In the 9 cases, 3 cardiac grafts resumed sinus rhythm automatically and four grafts resumed beating through electroshock. These 7 cases with rebeating cardiac graft survived with stable hemodynamics. Cardiac graft of the other two recipients was unable to resume the beating due to surgical problems in the early period of this experiment. CONCLUSION In addition to cardiac graft preservation and protection, appropriate CBP management is also critical to the successful orthotopic heart transplantation after longterm donor heart preservation in dogs.
参考文献/References
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备注/Memo
- 备注/Memo:
- 收稿日期：2006-11-23.通讯作者：陈忠华，主任医师，教授，主要从事器官移植和免疫学研究Email：zc104@medmail.com.cn 作者简介：徐利军，博士生Email：micxu@163.com
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