Rabin Joseph, Kaczorowski David J
R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, 110 South Paca Street, 7th Floor, Baltimore, MD 21201, USA.
Crit Care Clin. 2019 Jan;35(1):45-60. doi: 10.1016/j.ccc.2018.08.008. Epub 2018 Oct 25.
Management of the cardiac transplant recipient includes careful titration of inotropes and vasopressors. Recipient pulmonary hypertension and ventilatory status must be optimized to prevent allograft right ventricular failure. Vasoplegia, coagulopathy, arrhythmias, and renal dysfunction also require careful management to achieve an optimal outcome. Primary graft dysfunction (PGD) can be an ominous problem after cardiac transplantation. Although mild degrees of PGD may be managed medically, mechanical circulatory support with extracorporeal membrane oxygenation or temporary ventricular assist devices may be required. Retransplantation may be necessary in some cases.
心脏移植受者的管理包括仔细调整正性肌力药物和血管加压药物的剂量。必须优化受者的肺动脉高压和通气状态，以防止移植心脏右心室衰竭。血管麻痹、凝血功能障碍、心律失常和肾功能不全也需要仔细管理，以实现最佳结果。原发性移植心脏功能障碍（PGD）可能是心脏移植后一个不祥的问题。虽然轻度的PGD可以通过药物治疗，但可能需要使用体外膜肺氧合或临时心室辅助装置进行机械循环支持。在某些情况下可能需要再次移植。
