Zeng Z, Jiang Z, Wang C S, Luo H, Huang Y F, Jin X H
Department of Anesthesiology, Shanghai 6th People's Hospital Affiliated to Jiaotong University, Shanghai, China.
Transplant Proc. 2010 Nov;42(9):3708-10. doi: 10.1016/j.transproceed.2010.08.067.
The objectives of this study were to retrospectively analyze the value of preoperative evaluation and to analyze the risk factors of long-term mechanical ventilation in heart transplant recipients.
We analyzed the data of 106 patients prepared to receive heart transplants. Before the operation, according to the pulmonary vascular resistance (PVR) and transpulmonary gradient (TPG), the patients were divided into 2 groups: a pulmonary hypertension (PH) group and a pulmonary artery pressure normal (N) group. The vasodilator conditioning test as a predictive factor was performed in the PH group. Univariate analysis and logistic regression were used to examine the relationship between risk factors and long-term mechanical ventilation. The 30-day and long-term survival rates were followed.
PVR and TPG significantly decreased among the PH group after intravenous infusion epoprostenol and inhalation (nitric oxide). After preoperative evaluation, 96 patients underwent heart transplantation. There were no short-term deaths related to PH. There was no significant difference in mortality between the PH group and the N group. PH, hypotension after cardiopulmonary bypass, renal dysfunction, donor heart ischemia time, and ejection fraction <25% were risk factors for long-term mechanical ventilation. PH was not related to long-term deaths.
A vasodilator conditioning test was reliable for PH patients undergoing heart transplantation for preoperative evaluation and preparation.
本研究的目的是回顾性分析术前评估的价值，并分析心脏移植受者长期机械通气的危险因素。
我们分析了106例准备接受心脏移植患者的数据。术前，根据肺血管阻力（PVR）和跨肺压差（TPG），将患者分为2组：肺动脉高压（PH）组和肺动脉压力正常（N）组。对PH组进行血管扩张剂预处理试验作为预测因素。采用单因素分析和逻辑回归分析危险因素与长期机械通气之间的关系。随访30天和长期生存率。
PH组静脉输注依前列醇和吸入（一氧化氮）后，PVR和TPG显著降低。术前评估后，96例患者接受了心脏移植。没有与PH相关的短期死亡。PH组和N组之间的死亡率没有显著差异。PH、体外循环后低血压、肾功能不全、供心缺血时间和射血分数<25%是长期机械通气的危险因素。PH与长期死亡无关。
血管扩张剂预处理试验对接受心脏移植的PH患者进行术前评估和准备是可靠的。
