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儿童心脏移植的治疗进展与展望

朱家德, 吴敏. 儿童心脏移植的治疗进展与展望[J]. 器官移植, 2023, 14(1): 56-61. doi: 10.3969/j.issn.1674-7445.2023.01.007
引用本文: 朱家德, 吴敏. 儿童心脏移植的治疗进展与展望[J]. 器官移植, 2023, 14(1): 56-61. doi: 10.3969/j.issn.1674-7445.2023.01.007
Zhu Jiade, Wu Min. Progress and prospect of heart transplantation in children[J]. ORGAN TRANSPLANTATION, 2023, 14(1): 56-61. doi: 10.3969/j.issn.1674-7445.2023.01.007
Citation: Zhu Jiade, Wu Min. Progress and prospect of heart transplantation in children[J]. ORGAN TRANSPLANTATION, 2023, 14(1): 56-61. doi: 10.3969/j.issn.1674-7445.2023.01.007

儿童心脏移植的治疗进展与展望

doi: 10.3969/j.issn.1674-7445.2023.01.007
基金项目: 

广东省医学科学技术研究基金 A2020002

广州市科技计划项目 202102080011

详细信息
    作者简介:
    通讯作者:

    吴敏, Email: wumin0011@gdph.org.cn

  • 中图分类号: R617, R541

Progress and prospect of heart transplantation in children

More Information
  • 摘要: 儿童心脏移植是合并难以通过常规手术或药物进行治疗的顽固性心力衰竭儿童患者的标准治疗方式。目前,全球儿童心脏移植的开展愈发广泛,但国内的开展经验仍较为缺乏。近10年来儿童心脏移植已经取得了长足发展:一方面,儿童心脏移植手术例数逐年升高;另一方面,为解决儿童心脏移植供心缺乏等问题,ABO血型不相容心脏移植、应用儿童心室辅助装置、体质量不匹配移植等治疗策略被广泛应用。然而,国内儿童心脏移植开展经验十分有限,尤其在儿童心脏移植适应证把握、特殊儿童心脏移植策略应用等方面。本文对儿童心脏移植的发展历史、治疗策略进展及预后等做一综述。

     

  • 表  1  儿童心脏分配优先级标准[9]

    Table  1.   Priority criteria for heart allocation in children

    分级 标准
    1A级 需要持续机械通气,同时已入住登记移植的医院
    需要主动脉内球囊反搏支持,同时已入住登记移植的医院
    需要使用支架或静脉前列腺素保证动脉导管未闭状态以维持循环,同时已入住登记移植的医院
    先心病患儿出现严重的血流动力学不稳定,需要多种或单种大剂量强心药物维持,并且已收治到登记移植的医院;OPTN联络处备有先心病患者为满足1A类优先级别时需达到使用的强心药物种类及剂量
    需要机械循环辅助支持
    患者已收治入登记移植的医院,医师认为相比于该机构其他满足1A级梯队标准的患者,该患者移植需求更为急迫且通过移植获益更多(无论该患者是否达到1A级标准)
    1B级 需要使用血管活性药物但未达到1A级标准;OPTN联络处备有符合1B类优先级别的强心药物种类及剂量
    登记移植时 < 1岁,诊断为肥厚型或限制型心肌病
    医师认为相比于该机构其他满足1B级梯队标准的患者,该患者移植需求更为急迫且通过移植获益更多(无论该患者是否达到1B级标准)
    下载: 导出CSV

    表  2  3种VAD的主要特点比较

    Table  2.   Comparison of main characteristics among three types of VAD

    分类 出产国 血流方式 上市情况 目标人群 首次植入时间和地点 植入方式 应用范围
    EXCOR 德国 搏动 2014年,美国 婴幼儿 1990年,柏林 体外 BTT、心力衰竭康复治疗
    HeartWare HVAD 美国 直流 2009年,欧洲
    2011年,澳大利亚
    体表面积 > 0.7 m2或体质量≥25 kg儿童 2011年,柏林 体内 BTT
    Infant Jarvik 2015 美国 直流 尚未上市 体质量 > 8 kg儿童 未披露 体内 BTT
    下载: 导出CSV
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出版历程
  • 收稿日期:  2022-09-04
  • 网络出版日期:  2023-01-17
  • 刊出日期:  2023-01-15

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