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体外膜肺氧合在心脏移植术后早期移植物功能障碍中的应用

郑珊珊, 郑哲, 宋云虎, 等. 体外膜肺氧合在心脏移植术后早期移植物功能障碍中的应用[J]. 器官移植, 2023, 14(1): 93-99. doi: 10.3969/j.issn.1674-7445.2023.01.012
引用本文: 郑珊珊, 郑哲, 宋云虎, 等. 体外膜肺氧合在心脏移植术后早期移植物功能障碍中的应用[J]. 器官移植, 2023, 14(1): 93-99. doi: 10.3969/j.issn.1674-7445.2023.01.012
Zheng Shanshan, Zheng Zhe, Song Yunhu, et al. Application of extracorporeal membrane oxygenation in early allograft dysfunction after heart transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(1): 93-99. doi: 10.3969/j.issn.1674-7445.2023.01.012
Citation: Zheng Shanshan, Zheng Zhe, Song Yunhu, et al. Application of extracorporeal membrane oxygenation in early allograft dysfunction after heart transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(1): 93-99. doi: 10.3969/j.issn.1674-7445.2023.01.012

体外膜肺氧合在心脏移植术后早期移植物功能障碍中的应用

doi: 10.3969/j.issn.1674-7445.2023.01.012
基金项目: 

创新工程-中国医学科学院临床与转化医学研究专项 2022-I2M-C & T-B-038

详细信息
    作者简介:
    通讯作者:

    刘盛,博士,主任医师,研究方向为心脏移植及冠状动脉粥样硬化性心脏病、心脏瓣膜病、肺血栓栓塞等的外科治疗,Email:liusheng@fuwai.com

  • 中图分类号: R617, R541

Application of extracorporeal membrane oxygenation in early allograft dysfunction after heart transplantation

More Information
  • 摘要:   目的  分析体外膜肺氧合(ECMO)在心脏移植术后早期移植物功能障碍(EAD)中的应用效果。  方法  回顾性分析614例心脏移植受者的临床资料,根据术后是否使用ECMO分为ECMO组(43例)和非ECMO组(571例)。总结ECMO组受者心脏移植术后ECMO支持治疗情况,比较两组受者的围手术期情况和远期预后。  结果  43例ECMO支持受者中,17例因出血进行开胸探查,10例出现感染,4例出现下肢静脉血栓,1例出现脑卒中。26例受者成功脱离ECMO后康复出院,6例受者ECMO支持期间死亡,6例受者ECMO脱机后死亡,5例受者因无法脱离ECMO而接受再次移植,再次移植后仅1例存活。与非ECMO组比较,ECMO组术中体外循环时间较长,术后需要主动脉内球囊反搏(IABP)、肾功能不全需要透析、再次开胸止血、感染、机械通气时间≥96 h和气管切开比例较高,术后重症监护室(ICU)入住时间较长(均为P < 0.05)。ECMO组受者出院生存率和90 d生存率分别为63%和96%,低于非ECMO组的97%和100%,差异均有统计学意义(均为P < 0.05)。生存分析结果显示,ECMO组受者的远期生存率低于非ECMO组(P < 0.05); 当排除心脏移植术后90 d内死亡的受者后,两组之间的远期生存率差异无统计学意义(P > 0.05)。  结论  ECMO是治疗心脏移植术后EAD有效的方法。使用ECMO的受者心脏移植术后的早期生存率低于不使用ECMO的受者,而顺利度过心脏移植术后90 d远期生存率差异无统计学意义。

     

  • 图  1  2015年至2021年阜外医院接受心脏移植术后ECMO支持的受者人数

    Figure  1.  Number of recipients receiving ECMO support after heart transplantation in Fuwai Hospital from 2015 to 2021

    图  2  两组受者远期生存率比较

    注:A图为ECMO组和非ECMO组的Kaplan-Meier生存分析; B图为ECMO组和非ECMO组基于心脏移植术后90 d存活受者的Kaplan-Meier生存分析。

    Figure  2.  Comparison of long-term survival rate between two groups

    表  1  ECMO组和非ECMO组围手术期资料比较

    Table  1.   Comparison of perioperative data between ECMO group and non-ECMO group

    变量 ECMO组(n=43) 非ECMO组(n=571) 统计值 P
    术中体外循环时间[M(P25, P75),min] 307(256,333) 193(170,221) 8.22 < 0.01
    术中主动脉阻断时间[M(P25, P75),min] 73(60,85) 67(57,82) 1.35 0.18
    术后需要IABP[n(%)] 32(74) 118(21) 62.59 < 0.01
    术后肾功能不全需要透析[n(%)] 10(23) 15(3) 43.57 < 0.01
    术后需要再次开胸止血[n(%)] 17(40) 17(3) 102.17 < 0.01
    术后感染[n(%)] 10(23) 29(5) 22.21 < 0.01
    术后机械通气时间≥96 h[n(%)] 31(72) 30(5) 199.65 < 0.01
    术后气管切开[n(%)] 10(23) 11(2) 55.08 < 0.01
    术后ICU入住时间[M(P25, P75),d] 10(7,17) 5(4,7) 6.27 < 0.01
    术后总住院时间[M(P25, P75),d] 16(9,35) 17(14,22) -0.87 0.39
    出院存活[n(%)] 27(63) 553(97) 70.00 < 0.01
    出院时LVEF(x±s,%) 55±16 63±7 44.17 < 0.01
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  • 收稿日期:  2022-08-29
  • 网络出版日期:  2023-01-17
  • 刊出日期:  2023-01-15

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