在接受肝移植评估的患者中,可诱导的左心室外流通道阻塞的临床影响
Antoine Addoumieh1, Mouin S Abdallah1, Jad A Ballout1
1Heart and Vascular Institute, Cleveland Clinic Foundation, USA.
概括
在 dobutamine 应激心电图 (DSE) 中发现的诱导性左心室外流通道阻塞 (LVOTO) 不会对肝移植后的短期结果产生负面影响. 这一发现表明,LVOTO不应该是拒绝肝脏移植的唯一理由,以终末期肝脏疾病 (ESLD) 患者.
科学领域:
- 心脏病学 心脏病学
- 肝病学 肝病学是一种肝病学.
- 移植手术 移植手术
背景情况:
- 末期肝病 (ESLD) 具有高动态循环状态的特点.
- 在肝移植候选人的术前风险分层中,多布他胺应激心声学 (DSE) 是至关重要的.
- 可诱导的左心室外流通道阻塞 (LVOTO) 对移植后结果的影响需要进一步研究.
研究的目的:
- 为了确定通过DSE识别的诱导性LVOTO对肝移植后的短期结果的影响.
- 评估LVOTO存在是否影响术后重症监护室 (ICU) 停留或死亡率.
主要方法:
- 在克利夫兰诊所 (2007-2016) 进行肝移植之前接受DSE的515名患者的回顾性分析.
- 根据DSE发现,患者被分为具有和没有可诱导LVOTO的组.
- 在各组之间比较了手术前的DSE和手术后的ICU数据,包括停留时间和死亡率.
主要成果:
- 18%的患者 (515人中有95人) 在DSE期间表现出可诱导的LVOTO,峰值梯度达到90±48.2mmHg.
- 在LVOTO和没有LVOTO的患者之间,在ICU停留时间或机械通风持续时间方面没有发现显著差异.
- 30天死亡率相似:LVOTO组的2.1%与非LVOTO组的4.5% (p=0.28) 相比.
结论:
- 在手术前的DSE中发现的诱导性LVOTO似乎不会对肝移植后的短期结果产生不利影响.
- 诱导性LVOTO的存在不应该是排除ESLD患者从肝移植中排除的唯一标准.
- 更高的末期肝病模型 (MELD) 评分与更长时间的机械呼吸和ICU停留有关.
关键词:
肝硬化是肝硬化的一种疾病.多布胺压力回声心脏图谱动态左心室外流通道阻塞 动态左心室外流通道阻塞心声回声扫描 (Echocardiography) 是一种心声回声扫描.最终阶段的肝脏疾病.左心室外流通道阻塞 阻塞左心室外流通道肝移植评估 肝移植评估最终阶段肝病的模型орто托普肝移植是一种肝移植.压力成像 压力成像更多相关视频
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