| 摘要: |
| 目的 分析心脏移植患者术后早期三尖瓣反流的风险因素，总结心脏移植供受体评估及心脏移植围手术期的管理经验，以期提高心脏移植术后患者生存率、降低移植术后患者早期右心功能不全发生率。方法 选取2017年3月至2019年11月在我院接受同种原位心脏移植手术的74例患者作为研究对象，按术后三尖瓣反流束面积与右心房面积比值将患者分为两组：组1（15例，三尖瓣反流束面积与右心房面积比值<20%）和组2（59例，三尖瓣反流束面积与右心房面积比值≥20%）。根据供体心脏标准获取心脏，术前通过Swan-Ganz导管监测患者肺动脉收缩压（PAPs）等指标，采用超声心动图评价患者术后30 d内的三尖瓣反流程度。采用多因素logistic回归模型分析移植术后三尖瓣反流的影响因素。结果 原发性移植物功能衰竭（PGF）、急性排斥反应、供受体体重比和术前PAPs在两组间的差异均有统计学意义（P均<0.01），两组供体年龄、受体年龄、供受体性别是否匹配、术前NYHA心功能分级、原发病种类、供受体身高比、术前总胆红素水平及术前右心室前后径等的差异均无统计学意义（P均>0.05）。多因素logistic回归分析结果显示PGF（OR=1.892，95% CI 1.150～1.972）、急性排斥反应（OR=1.625，95% CI 1.190～1.885）、供受体体重比（OR=0.001，95% CI 0.000～0.873）和术前PAPs（OR=1.274，95% CI 1.099～1.498）是患者心脏移植术后早期三尖瓣反流的影响因素（P均<0.05）。结论 注重供受体体重的匹配、防治围手术期肺动脉高压、严格应用免疫抑制剂及预防PGF有利于降低心脏移植术后早期三尖瓣反流，减少右心功能衰竭发生。 |
| 关键词: 心脏移植 三尖瓣反流 心力衰竭 肺性高血压 原发性移植物功能衰竭 移植物排斥 |
| DOI：10.16781/j.0258-879x.2021.05.0469 |
| 投稿时间：2020-10-14修订日期：2021-03-09 |
| 基金项目:国家自然科学基金（81770383）. |
|
| Risk factors for early tricuspid regurgitation after heart transplantation |
| ZHANG Bo-yao,TANG Yang-feng,ZHANG Guan-xin,FAN Xing-li,ZHANG Jia-jun,XU Zhi-yun,HAN Lin* |
(Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To analyze the risk factors of early tricuspid regurgitation after heart transplantation, and to summarize the experience of donor and recipient evaluation and perioperative management of heart transplantation, so as to increase the survival rate and decrease the incidence of early right ventricular dysfunction in patients after heart transplantation. Methods A total of 74 patients who underwent orthotopic heart transplantation in our hospital from Mar. 2017 to Nov. 2019 were selected and divided into 2 groups according to the ratio of tricuspid regurgitation bundle area to right atrial area (group 1[15 cases, with the ratio<20%] and group 2[59 cases, with the ratio ≥ 20%]). The hearts were obtained according to the donor heart standards. The pulmonary artery systolic pressure (PAPs) and other indicators were monitored preoperatively by Swan-Ganz catheter, and the degree of tricuspid regurgitation within 30 days after surgery was evaluated by echocardiography. Multiple logistic regression model was used to analyze the influencing factors of early tricuspid regurgitation after heart transplantation. Results There were significant differences in primary graft failure (PGF), acute rejection, donor-to-recipient body weight ratio and preoperative PAPs between the two groups (all P<0.01). There were no significant differences in donor age, recipient age, donor and recipient gender match, preoperative New York Heart Association (NYHA) heart function classification, primary diseases, donor-to-recipient height ratio, preoperative total bilirubin level or preoperative right ventricular anteroposterior diameter between the two groups (all P>0.05). Multiple logistic regression analysis showed that PGF (odds ratio[OR]=1.892, 95% confidence interval[CI]1.150-1.972), acute rejection (OR=1.625, 95% CI 1.190-1.885), donor-to-recipient body weight ratio (OR=0.001, 95% CI 0.000-0.873) and preoperative PAPs (OR=1.274, 95% CI 1.099-1.498) were the influencing factors for early tricuspid regurgitation after heart transplantation (all P<0.05). Conclusion Matching the body weight of donor and recipient, preventing perioperative pulmonary hypertension, applying immunosuppressant strictly and preventing PGF are beneficial to reduce early tricuspid regurgitation and right heart failure after heart transplantation. |
| Key words: heart transplantation tricuspid regurgitation heart failure pulmonary hypertension primary graft failure graft rejection |
