心脏手术后心脏移植治疗复发性心源性休克1例。

Q3 Medicine
T Yang, H Y Ye, H K Liang
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引用次数: 0

摘要

2个月前因冠心病、二尖瓣反流、三尖瓣反流行冠状动脉旁路移植术、机械二尖瓣置换术、三尖瓣修复术的患者再次发生心力衰竭、心源性休克。经主动脉内球囊泵(IABP)支持1个月后心功能仍未恢复,再行静脉-动脉体外膜氧合(VA-ECMO)治疗。在VA-ECMO辅助手术过程中,存在复杂的凝血功能障碍,出血和血栓并存。给予抗感染药物治疗,调整抗凝、抗感染药物用量,输注血液制品,可改善凝血功能。VA-ECMO支持10天后进行心脏移植。心脏移植后依次发生右心衰、多发浆液积存(胸腔和腹腔)、肺部反复感染及血流、肝功能障碍、肾功能障碍、凝血功能障碍、气胸。经积极治疗,患者痊愈出院。受者生活质量良好,移植心脏功能基本正常。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Cardiac transplantation for recurrent cardiogenic shock following cardiac surgery: a case report].

Heart failure and cardiogenic shock occurred again on the patient who undergone coronary artery bypass grafting, mechanical mitral valve replacement, and tricuspid valve repair surgery for coronary heart disease, mitral regurgitation, and tricuspid valve regurgitation 2 months ago. His heart function could not recover after Intra-Aortic Balloon Pump (IABP) supported for 1 month, and then Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) was applied. During the VA-ECMO assisted procedure, complex coagulation dysfunction was present, bleeding and thrombosis was coexisting. Treatment with anti-infective drugs, adjustment dosage of anticoagulant and anti-infective drugs, and infusion of blood products, coagulation function was improved. Cardiac transplantation was applied after VA-ECMO support for 10 days. Right heart failure, multiple serosal fluid accumulation (in the chest and abdominal cavities), repeated infections in the lungs and blood flow, liver dysfunction, renal dysfunction, coagulation dysfunction, pneumothorax were occurred successively after cardiac transplantation. The patient recovered and discharged from the hospital after active treatment. The recipient's quality of life is good and the transplanted heart function is basically normal.

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CiteScore
0.80
自引率
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