合并肺动脉高压和肝肾功能衰竭ECMO桥接下行心脏移植1例

A Case of ECMO-Assisted Heart Transplantation with Pulmonary Hypertension and Liver/Kidney Failure

摘要: 心脏移植是解决终末期心脏病患者的主要有效治疗方法，但既往受者的选择多为一般状况较好、肺动脉压力不高、无肝肾功能损害、无需机械辅助的患者，危重症紧急状态的心脏移植较少。本文报道1例ECMO联合IABP辅助下合并肺动脉高压和肝肾功能衰竭的心脏移植患者，围术期出现二次开胸、感染、肺动脉高压、肝肾功能衰竭等并发症，经系统治疗后患者顺利出院，随访9月心功能良好，肝肾功能无明显异常，肺动脉压力基本降至正常，旨在为重症患者心脏移植和心源性肝肾功能衰竭围术期管理经验方面提供临床诊疗参考。

Abstract: Heart transplantation is the main effective treatment for patients with end-stage heart disease. Most of the recipients were selected for patients with good general condition, low pulmonary artery pressure, no liver and kidney function damage, and no need for mechanical assistance in the past, while it is rare in critical illness emergency. This paper reports a heart transplant patient assisted by ECMO and IABP, with pulmonary hypertension, liver and kidney failure. The patient had com-plications such as secondary thoracotomy, infection, pulmonary hypertension, liver and kidney failure during the perioperative period. After systemic treatment, the patient was discharged smoothly, followed up for 9 months with great cardiac function, normal liver and kidney function, and declined pulmonary artery pressure. The purpose of this study is to provide clinical reference for the perioperative management of heart transplantation and cardiogenic liver and kidney failure in critically ill patients.