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终末期心力衰竭受者术前肺动脉压对心脏移植围手术期预后的影响

周炜, 李白翎, 张冠鑫, 等. 终末期心力衰竭受者术前肺动脉压对心脏移植围手术期预后的影响[J]. 器官移植, 2023, 14(1): 100-105. doi: 10.3969/j.issn.1674-7445.2023.01.013
引用本文: 周炜, 李白翎, 张冠鑫, 等. 终末期心力衰竭受者术前肺动脉压对心脏移植围手术期预后的影响[J]. 器官移植, 2023, 14(1): 100-105. doi: 10.3969/j.issn.1674-7445.2023.01.013
Zhou Wei, Li Bailing, Zhang Guanxin, et al. Effect of preoperative pulmonary artery pressure on perioperative prognosis of recipients with end-stage heart failure undergoing heart transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(1): 100-105. doi: 10.3969/j.issn.1674-7445.2023.01.013
Citation: Zhou Wei, Li Bailing, Zhang Guanxin, et al. Effect of preoperative pulmonary artery pressure on perioperative prognosis of recipients with end-stage heart failure undergoing heart transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(1): 100-105. doi: 10.3969/j.issn.1674-7445.2023.01.013

终末期心力衰竭受者术前肺动脉压对心脏移植围手术期预后的影响

doi: 10.3969/j.issn.1674-7445.2023.01.013
基金项目: 

国家自然科学基金 81770383

上海市生物医药科技支撑专项 22S31904300

医院重点攻关项目 2020YSL007

详细信息
    作者简介:
    通讯作者:

    范兴例,硕士,主治医师,研究方向为心脏外科、心力衰竭,Email: dr_fxl@163.com

    韩林,博士,主任医师,研究方向为心脏外科、心脏移植,Email: sh_hanlin@163.com

  • 中图分类号: R617, R541.6

Effect of preoperative pulmonary artery pressure on perioperative prognosis of recipients with end-stage heart failure undergoing heart transplantation

More Information
  • 摘要:   目的  探讨终末期心力衰竭受者术前肺动脉压对心脏移植围手术期预后的影响。  方法  回顾性分析行心脏移植手术的105例受者临床资料,以肺动脉平均压(mPAP)作为诊断标准,确定mPAP预测心脏移植预后的最佳临界值,根据临界值将受者分为低mPAP组(66例)和高mPAP组(39例)。比较低mPAP组和高mPAP组受者的术中指标(体外循环时间、主动脉阻断时间、辅助循环时间、供心冷缺血时间)和术后指标[主动脉内球囊反搏(IABP)支持率、IABP辅助时间、体外膜肺氧合(ECMO)支持率、ECMO辅助时间、机械通气时间、重症监护室(ICU)入住时间、三尖瓣中重度反流率、围手术期病死率],比较两组受者的预后情况。  结果  mPAP预测心脏移植预后的最佳临界值为30.5 mmHg。高mPAP组受者的ECMO支持率和围手术期病死率均高于低mPAP组(均为P < 0.05); 两组受者的体外循环时间、主动脉阻断时间、辅助循环时间、供心冷缺血时间、IABP支持率、IABP辅助时间、ECMO辅助时间、机械通气时间、ICU入住时间、三尖瓣中重度反流率差异均无统计学意义(均为P > 0.05)。高mPAP组和低mPAP组受者的术后1、2、3、4年的生存率间差异均无统计学意义(均为P > 0.05)。  结论  终末期心力衰竭患者术前肺动脉压力与心脏移植围手术期预后密切相关,mPAP=30.5 mmHg是预测心脏移植受者围手术期预后的最佳临界值,高mPAP组受者围手术期ECMO支持率高,围手术期病死率高,但并未对术后中、远期预后产生影响。

     

  • 图  1  mPAP预测心脏移植预后的ROC曲线

    Figure  1.  ROC curve of mPAP in predicting the prognosis of heart transplantation

    图  2  两组受者的术后生存曲线分析

    Figure  2.  Postoperative survival curve analysis of recipients between the two groups

    表  1  两组受者术中及术后指标的比较

    Table  1.   Comparison of intraoperative and postoperative parameters of recipients between the two groups

    变量 低mPAP组(n=66) 高mPAP组(n=39) P
    体外循环时间(x±s,min) 139±42 150±38 0.127
    主动脉阻断时间(x±s,min) 43±11 45±10 0.193
    辅助循环时间(x±s,min) 89±43 96±41 0.321
    供心冷缺血时间[M(P25P75),min] 112(63,324) 132(72,326) 0.486
    IABP支持率[n(%)] 10(15) 12(31) 0.057
    IABP辅助时间[M(P25P75),h] 156(100,227) 168(132,228) 0.772
    ECMO支持率[n(%)] 7(11) 11(28) 0.021
    ECMO辅助时间(x±s,h) 167±81 157±57 0.500
    机械通气时间[M(P25P75),h] 19(11,36) 24(12,51) 0.080
    ICU入住时间(x±s,d) 13±6 13±6 0.981
    三尖瓣中重度反流率[n(%)] 15(23) 10(26) 0.735
    围手术期病死率[n(%)] 1(2) 6(15) 0.024
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出版历程
  • 收稿日期:  2022-08-06
  • 网络出版日期:  2023-01-17
  • 刊出日期:  2023-01-15

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