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中华重症医学电子杂志

中华重症医学电子杂志 ›› 2020, Vol. 06 ›› Issue (02) : 178 -182. doi: 10.3877/cma.j.issn.2096-1537.2020.02.015

所属专题： 文献；

临床研究

实体器官移植患者接受心脏外科手术的围术期分析
张毅杰1, 屠国伟1, 苏迎1, 罗竞超1, 王春生2, 罗哲1,†()   
  1. 1. 200032　上海，复旦大学附属中山医院重症医学科
    2. 200032　上海，复旦大学附属中山医院心脏外科
  • 收稿日期:2019-12-28 出版日期:2020-05-28
  • 通信作者: 罗哲
  • 基金资助:
    上海市卫生健康系统重要薄弱学科建设基金(2019ZB0105); 中山医院厦门医院临床科室学科建设基金(XYYX201922); 中山医院优秀青年基金(2019ZSYXQN34); 中山医院青年基金(2019ZSQN13，2018ZSQN53)

Perioperative outcomes of cardiosurgical patients with a history of solid organ transplantation

Yijie Zhang1, Guowei Tu1, Ying Su1, Jingchao Luo1, Chunsheng Wang2, Zhe Luo1,†()   

  1. 1. Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
    2. Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
  • Received:2019-12-28 Published:2020-05-28
  • Corresponding author: Zhe Luo
  • About author:
    Corresponding author: Luo Zhe, Email:
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引用本文：

张毅杰, 屠国伟, 苏迎, 罗竞超, 王春生, 罗哲. 实体器官移植患者接受心脏外科手术的围术期分析[J/OL]. 中华重症医学电子杂志, 2020, 06(02): 178-182.

Yijie Zhang, Guowei Tu, Ying Su, Jingchao Luo, Chunsheng Wang, Zhe Luo. Perioperative outcomes of cardiosurgical patients with a history of solid organ transplantation[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2020, 06(02): 178-182.

目的

评估实体器官移植患者接受心脏外科手术的安全性和预后。

方法

回顾性收集2010年1月至2019年8月期间复旦大学附属中山医院收治的实体器官移植术后接受心脏外科手术患者的临床资料，包括年龄、性别、基础疾病、器官移植种类、器官移植至本次心脏外科手术时间、辅助检查、手术情况、围术期并发症、重症监护病房住院时间、总住院时间，并对存活患者进行随访。

结果

共纳入14例实体器官移植患者，其中12例（85.7%）为肾移植，1例（7.1%）为肝移植，1例（7.1%）为心脏移植。患者平均年龄（57.5±6.0）岁，移植至本次心脏外科手术平均时间（11.4±5.5）年。平均重症监护病房住院时间（3.6±4.3）天，平均住医院时间（18.4±8.4）天。围术期并发症包括急性肾损伤2例（14.3%），其中1例（7.1%）需要行连续性肾脏替代治；新发心房颤动1例（7.1%）；术后感染3例（21.4%），均为肺部感染。30 d内死亡患者2例（14.3%）。存活患者随访3~124个月，平均（38.7±40.3）个月，随访期间无患者死亡，均未出现再住院治疗。

结论

实体器官移植患者接受心脏外科手术具有良好的短期及长期预后。然而，围术期的感染风险、术后急性肾损伤的发生仍需密切关注。

关键词: 肾移植, 肝移植, 心脏移植, 心脏外科手术
Objective

To evaluate the safety and outcomes of cardiac surgery in solid organ transplant recipients.

Methods

From January 2010 to August 2019, recipients of solid organ transplantation undergoing cardiac surgery at Zhongshan Hospital, Fudan University were enrolled in this study. Clinical data were retrospectively collected, including age, gender, primary diseases, organ transplantation, time from organ transplantation to cardiac surgery, biochemical data, operative data, perioperative complications, length of stay in ICU (LOS in ICU), length of stay in hospital, and follow-up data of survival patients.

Results

A total of 14 recipients were enrolled, including 12 (85.7%) recipients of kidney transplantation, 1 (7.1%) liver transplantation, and 1 (7.1%) heart transplantation. The average age of the patients was (57.5±6.0) years, and the average time from transplantation to cardiac surgery was (11.4±5.5) years. The mean LOS in ICU was (3.6±4.3) days, and the mean LOS in hospital was (18.4±8.4) days. Acute kidney injury (AKI) occurred in 2 (14.3%) patients, one of whom required continuous renal replacement therapy (CRRT). New-onset atrial fibrillation occurred in 1 (7.1%) patient. Postoperative infection occurred in 3 (21.4%) patients, whose type of infection was lung infection. Two (14.3%) patients died within 30 days. The surviving patients were followed for 3-124 months, with an average of (38.73±40.3) months. During the follow-up period, no patient died and no re-hospitalization occurred.

Conclusion

Solid organ transplant recipients receiving cardiac surgery have good short-term and long-term outcomes. However, complications of infection and AKI during the perioperative period are common.

Key words: Kidney transplantation, Liver transplantation, Heart transplantation, Cardiac surgical procedures
表1 14例接受心脏外科手术的实体器官移植患者的一般资料
编号 年龄 性别 体质量指数（kg/m2） 原发病 移植器官 移植后时间（年） 高血压 糖尿病 LVEF（%） NT-proBNP （pg/ml） 肌酐（mmol/L） 免疫抑制方案
1 49 男 21.1 ARD＋AR 肾脏 16 ＋ - 65 8769 144 CsA＋MMF＋Pred
2 51 男 23.2 AI 肾脏 6 ＋ - 67 129 123 CsA＋MMF＋Pred
3 72 男 23.7 CAD 肝脏 12 - - 68 335 104 CsA＋MMF＋Pred
4 54 女 22.1 AD 肾脏 11 ＋ - 74 284 87 CsA＋MMF＋Pred
5 59 男 26.6 CAD 肾脏 19 ＋ ＋ 51 23 489 270 CsA＋Pred
6 54 男 24.2 CAD 肾脏 20 ＋ - 46 >35 000 1307 FK506＋MMF＋Pred
7 57 男 19.0 ARD＋AR＋MR＋CAD 肾脏 15 ＋ - 50 >35 000 509 CsA＋MMF＋Pred
8 47 男 22.1 AR＋CAD 肾脏 16 ＋ - 62 289 163 CsA＋MMF
9 22 男 20.3 MI 肾脏 4 - - 69 13 642 97 CsA＋MMF＋Pred
10 47 男 19.4 ARA＋AR 肾脏 15 ＋ - 53 1300 94 MMF＋Pred
11 51 男 25.7 CAD 肾脏 7 ＋ - 58 1406 116 CsA＋MMF＋Pred
12 64 男 19.1 CM 肾脏 5 ＋ - 61 516 81 CsA＋Pred
13 61 男 29.0 CAD 肾脏 6 ＋ ＋ 52 4359 92 CsA＋ MMF＋ Pred
14 54 男 24.2 肺动脉狭窄 心脏 7 ＋ - 64 5285 109 FK506＋ MMF＋ Pred
表2 14例接受心脏外科手术的实体器官移植患者的围术期资料及预后
编号 手术方式 手术时间（min） CPB时间（min） 重症监护病房住院时间（d） 总住院天数（d） 围术期并发症 30 d预后
1 Bentall术 205 93 1 11 - 存活
2 主动脉瓣置换术 155 50 1 13 - 存活
3 OPCABG 255 - 1 11 - 存活
4 升主动脉+全弓置换术 300 119 4 18 肺部感染 存活
5 OPCABG 330 - 3 13 AKI 死亡
6 OPCABG 197 - 6 21 - 存活
7 Bentall术＋二尖瓣成形术＋CABG 628 511 16 29 肺部感染、脓毒症 死亡
8 冠状动脉搭桥术＋主动脉瓣置换术 259 77 1 17 AKI 存活
9 二尖瓣成形术 215 114 9 18 - 存活
10 Bentall术 292 109 2 28 肺部感染 存活
11 OPCABG 220 - 1 16 - 存活
12 左心房黏液瘤切除术 110 43 1 12 - 存活
13 OPCABG 131 - 2 11 - 存活
14 肺动脉补片加宽术 359 166 2 39 - 存活
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