Abstract:

Objective To investigate the application effect of the multidisciplinary collaborationmodel under the concept of enhanced recovery after surgery （ERAS） in heart transplantation. Methods Retrospective analysis of the clinical data of patients undergoing heart transplantation in the 7th People's Hospital of Zhengzhou from 1 May 2018 to 31 October 2024 was performed. Transpulmonary pressure gradient cut-off values were calculated. The patients were grouped according to the cut-off values， and the baseline and prognostic data of the two groups were compared. Results The 331 adult heart transplant patients were included in this study. The TPG cut-off value of 12 mmHg was calculated by X-tile software. The 331 patients were divided into two groupsTPG ＞ 12 mmHg（93 patients）and TPG ≤ 12 mmHg（238 patients）. The results of univariate analysis showed significant differences between the two groups in cardiac discharge index， mean pulmonary artery pressure， PAWPand PVR（P ＜ 0.001），No differences were observed in recipient gender， blood group， MV， ECMO， IABP，CRRT， preoperative cytomegalovirus （CMV） infection， pretransplantation infection， recipient age， height， weight，recipient right ventricular mass， recipient left ventricular mass， donor age， donor weight ， donor height， recipient right ventricular mass， recipient left ventricular mass， donor age， donor height， recipient right ventricular mass，recipient left ventricular mass， donor age， donor weight， donor height， recipient right ventricular mass， recipient left ventricular mass， donor sex， donor blood type， cold ischaemia time， ascending aortic block time， postoperative IABP， postoperative ECMO and postoperative CRRT （all P ＞ 0.05）. In terms of prognosis， the prognostic analysisshowed that there were statistically significant differences between the two groups in terms of extracorporeal circulation time， duration of surgery， survival time， survival， length of stay in the care unit， and length of postoperative hospitalisation（P ＜ 0.05）. Survival analysis showed that TPG ≤ 12 mmHg group had a significantly higher survivalrate than the TPG ＞ 12 mmHg group（P ＜ 0.05）. The right ventricular mass disparity ratio and patient survivalquality showed a linear relationship， right ventricular mass difference ratio ＞ 0.13 will increases the survivalrate of patients. Conclusion Pre-transplant TPG ＞ 12 mmHg significantly reduces the survival prognosis of heart transplant patients， and there is a linear relationship between the right ventricular mass difference ratio and the survival quality of patients， the right ventricular mass difference ratio ＞ 0.13 improves the survival prognosis of patients. 

Key words:

"> Adults heart transplantation ； , Transpulmonary pressure gradient ； , Right ventricular mass difference ratio； , Prognostic analysis； , Survival rate

摘要：

目的 探讨基于右心室质量差值比率和经肺压力梯度评估是否能够评估成人心脏移植预后。方法 回顾性分析 2018 年 5 月 1 日至 2024 年 10 月 31 郑州市第七人民医院进行心脏移植患者的临床资料。计算经肺压力梯度断值，根据截断值进行分组，比较两组的基线资料和预后资料。结果 共 331 例成人心脏移植患者纳入本研究。通过 X-tile 软件计算出 TPG 截断值为 12 mmHg（1 mmHg ＝ 0.133 kPa）。将 331 例患者分成两组，经肺压力梯度（transpulmonary gradient，TPG）＞ 12 mmHg 组（93 例），TPG ≤ 12 mmHg 组（238 例）。单因素分析结果显示，两组在心排指数、平均肺动脉压力、肺毛细血管楔压（pulmonary artery wedge pressure，PAWP）、肺血管阻力（pulmonary vascular resistance， PVR）方面统计学存在显著差异（均 P ＜ 0.001）。在受体性别、血型、机械通气（mechanical ventilation，MV）、体外膜肺氧合（extra-corporealmembrane oxygenation，ECMO）、主动脉内球囊反搏（intraaortic balloon pump，IABP）、连续性肾脏替代治疗（continuous renal replacement therapy，CRRT）、术前巨细胞病毒（cytomegalovirus，CMV）感染、移植前感染、受体年龄、身高、体重、受右心室质量、受左心室质量、供体年龄、供体体重、供体身高、供右心室质量、受左心室质量、供体年龄、供体身高、供右心室质量、供左心室质量、供体年龄、供体体重、供体身高、供右心室质量、供左心室质量、供体性别、供血型、冷缺血时间、升主动脉阻断时间、术后 IABP、术后 ECMO、术后 CRRT 方面，无统计学意义（均 P ＞ 0.05）。预后分析显示 ：两组在体外循环时间、手术时长、生存时间、生存情况、监护室停留时间、术后住院时长方面，统计学有显著差异（P ＜ 0.05）。生存分析结果显示 TPG ≤ 12 mmHg 组生存率显著高于 TPG ＞ 12 mmHg 组（P ＜ 0.05），且右心室质量差值比率与患者生存质量存在线性关系，右心室质量差值比率＞ 0.13 会提高患者生存率。结论 移植前 TPG ＞12 mmHg 显著降低心脏移植患者的生存预后，且右心室质量差值比率与患者生存质量存在线性关系，右心室质量差值比率＞ 0.13 会提高患者生存预后。 

关键词:

成人心脏移植 , 经肺压力梯度 , 右心室质量差值比率 , 预后分析 , 生存率