Abstract:

Objective To analyze the fluid management plan and early clinical outcomes of patients after heart transplantation. Methods The clinical data of 121 heart transplant recipients were retrospectively analyzed in Chinese Academy of Medical Sciences Fuwai Hospital. The data on early fluid usage of the patients were sorted out and analyzed. Meanwhile， the occurrence and clinical outcomes of the main early complications of heart transplant patients after surgery were summarized and described. Results The negative fluid balance on the day after surgery was （1729.5±861.8） ml. The negative fluid balance from the 1st to the 3rd day after surgery was （1138.6±805.2） ml，（696.7±779.2） ml， and （527.1±694.3） ml respectively. The amount of colloid used on the day after surgery was 826.4±503.0 ml， and the average venous pressure was （3.0±2.0） mmHg. A total of 4 patients died in the hospital. Postoperative blood transfusion accounted for 14.9%， postoperative application of CRRT accounted for 5.0%， and secondary thoracotomy exploration accounted for 5.8%. Conclusion For heart transplant patients after surgery， the early management was guided by central venous pressure， in addition to floating catheter parameters， and through multiparameter guided dynamic fluid management. The risk of in-hospital death and the incidence of major complications of hearttransplant patients after surgery were at a relatively low level. 

Key words:

eart Transplantation, ； Fluid Management ； Intra-aortic Balloon Pump ； Extracorporeal Membrane Oxygenation； Heart Failure

摘要：

目的 分析心脏移植患者术后的液体管理方案与早期临床结果。方法 回顾性分析中国医学科学院阜外医院 121 例心脏移植受者的临床资料，整理患者术后早期液体使用数据并进行分析，同时总结描述心 脏移植患者术后的早期主要并发症发生情况及临床结果。结果 患者术后当日容量负平衡（1729.5±861.8）ml，术后第 1 天至第 3 天分别负平衡（1138.6±805.2）ml、（696.7±779.2）ml（527.1±694.3）ml，术后当日胶体用量为（826.4±503.0）ml，平均静脉压（3.0±2.0） mmHg。全部患者院内死亡共计 4 例，术后输血占 14.9%，术后应用 CRRT 占 5.0%，二次开胸探查占 5.8%。结论 心脏移植患者术后早期以中心静脉压、床旁超声、漂浮导管参数等为导引，通过多参数导向性动态容量管理，心脏移植患者术后院内死亡风险及主要并发症的发生率处于较低水平。

关键词:

心脏移植 , 液体管理 , 主动脉内球囊反搏泵 , 体外膜肺氧合 , 心力衰竭