器官捐献时代的心脏移植 ppt课件.ppt

* * * * 因此，如果有一种技术可以给器官持续灌流，尽量避免再灌注时的损伤，值得研究与探讨。 * * 因此，如果有一种技术可以给器官持续灌流，尽量避免再灌注时的损伤，值得研究与探讨。 * Survival was calculated using the Kaplan-Meier method, which incorporates information from all transplants for whom any follow-up has been provided. Since many patients are still alive and some patients have been lost to follow-up, the survival rates are estimates rather than exact rates because the time of death is not known for all patients. The median survival is the estimated time point at which 50% of all of the recipients have died. Survival rates were compared using the log-rank test statistic. Adjustments for multiple comparisons were done using Scheffe’s method. * Survival was calculated using the Kaplan-Meier method, which incorporates information from all transplants for whom any follow-up has been provided. Since many patients are still alive and some patients have been lost to follow-up, the survival rates are estimates rather than exact rates because the time of death is not known for all patients. The median survival is the estimated time point at which 50% of all of the recipients have died. Survival rates were compared using the log-rank test statistic. Adjustments for multiple comparisons were done using Scheffe’s method. * * 绝对适应症是血流动力学恶化，心源性休克，依赖静脉血管活性药物支持的病人。严重心肌缺血使活动受限，无法用药物血管重建解决的病人。恶性心律失常的病人少，占不到5%。 不合适的适应症是仅有LVEF低 或 NYHA心功能 III - IV 病史，但MaxVO215 mL/kg/min的一些不移植一年生存率90%的病人。 相对适应症 是 MaxVO2 11-14 mL/kg的一些治疗效果反复不好的病人。 * * 对难治性心衰患者首先应该明确是否存在潜在的、可能恢复的因素，以及评价目前治疗药物的充分性和有效性。 对于缺血性心脏病和瓣膜性心脏病的病人，要评价存活心肌和瓣膜疾病的严重程度，以明确是否有介入或者外科手术的指征； 影响心衰治疗效果的有害因素，如酗酒，毒品或非甾体类抗炎药致使钠水储溜药物如未停止使用。药物治疗达到最佳方案后，给予病人几个月最佳药物治疗的时间以评价药物治疗效果。仍持续表现为IIIB/IV心衰，就应该开始HTx相关评价。 * 有活动能力的患者需要做3项评估，如达到Max VO210ml/min/kg，SHFM 生存率1年80%，HFSS中高危就进入移植等待名单 如Max VO214ml/min/kg，SHFM生存率1年90%，HFSS 低危不适宜移植。 介于2者之间的慢性心衰状态，需动态评价移植时机。 * * Multivariable analysis was performed using a proportional hazards model censoring all patients at 1 year. Continuous factors were fit using a restricted c