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中华移植杂志(电子版) ›› 2019, Vol. 13 ›› Issue (01) : 1 -7. doi: 10.3877/cma.j.issn.1674-3903.2019.01.001

所属专题: 指南与规范 专题评论 文献 指南共识

诊疗规范

中国心脏移植受者术前评估与准备技术规范(2019版)
中华医学会器官移植学分会   
  • 收稿日期:2019-01-17 出版日期:2019-02-25

Technical specification for preoperative evaluation and preparation of heart transplantation recipients in China (2019 edition)

Branch of Organ Transplantation of Chinese Medical Association   

  • Received:2019-01-17 Published:2019-02-25
引用本文:

中华医学会器官移植学分会. 中国心脏移植受者术前评估与准备技术规范(2019版)[J]. 中华移植杂志(电子版), 2019, 13(01): 1-7.

Branch of Organ Transplantation of Chinese Medical Association. Technical specification for preoperative evaluation and preparation of heart transplantation recipients in China (2019 edition)[J]. Chinese Journal of Transplantation(Electronic Edition), 2019, 13(01): 1-7.

由于供心资源稀缺,必须对心脏移植候选者进行严格选择,仔细衡量风险和获益,评估其是否适合接受心脏移植。入选心脏移植等待名单的候选者需进行全面的术前评估,最大限度改善心功能和各器官功能状态;同时,接受详细的术前检查,以确保心脏以外器官功能可耐受心脏移植手术及术后免疫抑制治疗。为了进一步规范心脏移植受者选择以及术前评估和准备,中华医学会器官移植学分会组织心脏移植专家,总结相关国内外最新进展,结合国际指南和临床实践,从心脏移植适应证、禁忌证、移植候选者筛选和评估以及术前检查和准备等方面,制订中国心脏移植受者术前评估与准备技术规范(2019版)。

表1 心脏移植适应证
表2 心脏移植禁忌证
绝对禁忌证
? (1)合并系统性疾病,预计生存期<2年,包括活动性/近期发现的实体器官/血液系统恶性肿瘤
? (2)累及多系统的活动性红斑狼疮、结节病或淀粉样变性
? (3)不可逆的肾或肝功能不全且无法行联合移植
? (4)临床症状严重且未能进行血管再通的脑血管疾病
? (5)严重阻塞性肺疾病,FEV1<1 L
? (6)不可逆的肺动脉高压
? ? 肺动脉收缩压>60 mmHg
? ? 平均跨肺动脉压力梯度>15 mmHg
? ? 肺血管阻力>6 Wood单位
相对禁忌证
? (1)年龄>72岁
? (2)任何活动性感染(VAD导致的器械相关性感染除外)
? (3)活动性消化性溃疡
? (4)严重糖尿病并发神经病变、肾病和视网膜病等
? (5)严重的外周和中枢血管疾病
? ? 不能外科手术/介入治疗的外周血管疾病
? ? 有症状的颈动脉狭窄
? ? 未矫正的>6 cm的腹主动脉瘤
? (6)病理性肥胖(体质指数>35 kg/m2)或者恶液质(体质指数<18 kg/m2)
? (7)不可逆的血清肌酐>2.5 mg/dL或肌酐清除率<25 mL/min(心肾联合移植除外)
? (8)总胆红素>2.5 mg/dL,血清转氨酶超过正常值3倍以上,未服用华法林的情况下INR>1.5
? (9)严重肺功能不全,FEV1<40%预计值
? (10)6~8周内发生的肺梗死
? (11)难以控制的高血压
? (12)严重不可逆的神经或神经肌肉疾病
? (13)活动性情感疾病/精神状态不稳定
? (14)6个月内有药物、烟草或酒精滥用史
? (15)100 d内有肝素诱导的血小板减少史
图1 心脏移植候选者筛选流程
图2 心脏移植受者评估流程
表3 心脏移植受者术前危险因素评估
1
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