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Criteria for Selecting Patients for Inclusion in the Waiting List for Heart Transplantation 心脏移植候诊患者的选择标准
Pub Date : 2020-12-16 DOI: 10.30702/TRANSPAORG/07_20.0112/089-107/7-002
O. Tanska
Objective. The aim of the study was to optimize the methods of selecting patients for inclusion in the «waiting list» for heart transplantation on the basis of available international data and the introduction of selection criteria.Materials and methods. The results of the study are based on survey data and dynamic monitoring of 49 patients (median age 38 (16; 65) years; 44 men, 5 women) who were treated from 2008-2018 in the centers: Republican Scientific and Practical Center «Cardiology», Minsk, Republic of Belarus; in the Center of cardiac surgery on the basis of Hospital «Feofania». Patients were examined during the initial examination, after 3 months, 6 months and after 1 year. Results and discussion. The first group consisted of 24 patients with CHF who were on the waiting list for orthotopic heart transplantation, for circulatory support, median age 40.95 (18.0; 65.0) years, men - 23, women - 1; The second group consisted of 25 patients with CHF who were on the waiting list fororthotopic heart transplantation without circulatory support, median age 38.56 (17.0; 64.0) years, men - 21, women - 4.Conclusions. Scientific novelty of the obtained results. For the first time in Ukraine, a road map has been developed and implemented and the dynamics of the movement of recipients who are in the «waiting list» for heart transplantation has been analyzed. Identified risk factors that affect the long-term outcomes and quality of life of patients with heart failure III-IV functional class according to the NYHA classification. Criteria for selection of patients for primary heart transplantation have been developed and implemented. For the first time in Ukraine, a «waiting list» for a heart transplant has been formed.
目标。该研究的目的是在现有国际数据和引入选择标准的基础上,优化将患者纳入心脏移植“等待名单”的方法。材料和方法。该研究结果基于49例患者(中位年龄38岁,16岁;65)年;44名男性,5名女性)于2008-2018年在以下中心接受治疗:白俄罗斯共和国明斯克共和国科学与实践中心«心脏病学»;在Feofania医院的心脏外科中心工作。患者分别在初次检查、3个月、6个月和1年后进行检查。结果和讨论。第一组包括24例等待原位心脏移植的CHF患者,用于循环支持,中位年龄40.95 (18.0;65.0岁,男性23岁,女性1岁;第二组包括25例CHF患者,他们正在等待无循环支持的原位心脏移植,中位年龄38.56 (17.0;64.0)岁,男性21岁,女性4岁。取得成果的科学新颖性。在乌克兰,首次制定和实施了路线图,并分析了心脏移植“等候名单”中的受者的流动动态。根据NYHA分级确定影响III-IV功能级心衰患者长期预后和生活质量的危险因素。原发性心脏移植患者的选择标准已经制定并实施。乌克兰首次出现了心脏移植的“等待名单”。
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引用次数: 0
Surgical Restoration of the Skin in Patients with Trophic Ulcers of Various Origins 各种来源的营养性溃疡患者皮肤的外科修复
Pub Date : 2020-12-16 DOI: 10.30702/TRANSPAORG/03_20.0112/040-049/44-089
V. Boyko, A. V. Kravtsov, Yu. I. Isaev, Yu. I. Kozin, T. Kurbanov
A study of the effectiveness of surgical treatment aimed at restoring the skin in 176 patients with trophic ulcers of vascular origin. An algorithm of conservative, local and surgical treatment has been developed, which provides full-fledged replacement of the ulcer defect by performing autodermoplasty operations.Objective. To improve the results of skin plastic operations in the treatment of trophic ulcers based on the optimization of the staged preparation, the performance of surgical intervention and the postoperative management of the wound defect.Materials and methods. The operations of skin grafting over the past 5 years have been performed by us in 176 patients with trophic ulcers. The area of the wound defect ranged from 10 cm2 to 1000 cm2. An algorithm of treatment was developed and used in clinical practice, consisting of 8 stages aimed at preparing ulcers, performing skin grafting, postoperative treatment, and post-transplant adaptation of skin flaps. Results and discussion. In the course of the treatment, general infusion, drug therapy and local treatment were carried out against the background of which excision of pathological granulations, preparation of wounds, skin plasty and postoperative treatment were performed.A long-lasting positive functional and aesthetic effect was obtained.Conclusions. An algorithm has been developed for the complex treatment of trophic ulcers, including a skin transplantation operation, the clinical application of which provides a longterm healing of a wound defect and an improvement in the quality of life of patients.
176例血管源性营养性溃疡患者皮肤修复手术治疗效果的研究。一种保守、局部和手术治疗的方法,通过自体皮肤成形术提供了溃疡缺损的全面替代。通过优化手术阶段准备、手术干预表现和创面缺损术后处理,提高皮肤整形手术治疗营养性溃疡的效果。材料和方法。在过去的5年中,我们为176例营养性溃疡患者进行了植皮手术。创面缺损面积从10 ~ 1000平方厘米不等。我们开发了一种治疗算法并应用于临床实践,包括8个阶段,旨在准备溃疡,进行皮肤移植,术后治疗和移植后皮瓣的适应。结果和讨论。治疗过程中进行全身输注、药物治疗和局部治疗,病理肉芽切除、创面制备、皮肤成形术及术后治疗。获得了持久的积极的功能和美学效果。已经开发出一种用于营养性溃疡复杂治疗的算法,包括皮肤移植手术,其临床应用提供了伤口缺损的长期愈合和患者生活质量的改善。
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引用次数: 0
Transplantation and artificial organs 1(01) 2020 移植与人工器官1(01)2020
Pub Date : 2020-12-16 DOI: 10.30702/TRANSPAORG/01_20.0112/06-017/844
O. H. Kotenko, A. Minich, M. Grygorian
Changes in liver blood flow and functional status of liver transplants with different types of venous outflow reconstruction have not been fully studied. A graft with optimal blood flow characteristics in a living family donation is one of the key factors that determines its functional state. The Aim. Comparison of regional hemodynamics of the liver and biochemical parametersof blood after transplantation of the right lobe from a living related donor with and without amedian vein.Materials and methods. Based on our algorithm, which included analysis of the variational anatomy of the hepatic veins of the donor to determine the type of dominant vein, transplants were selected for 76 recipients: 39 patients (group 1) were transplanted right lobe of the middle vein and 37 patients (group 2) – right lobe without meddle vein. For comparative analysis, we used data from blood biochemical parameters and data from regional hemodynamics of grafts: volumetric portal blood flow, linear velocity and resistance index in the hepatic artery in both groups during the first week and on the 10th, 14th, 21st, 30th day after transplantation.Results. Using the described graft selection algorithm, we obtained the following results on the 30th day after transplantation: in group 1 there were higher values of volumetric portal blood flow compared to group 2 at all stages of observation (1110 ± 62 ml/min and 922 ± 41 ml/min, p = 0,013864 in groups 1 and 2, respectively); the resistance index in the hepatic artery was statistically significantly higher in group 2 – 0.61 ± 0.01 compared with group 1 (0.63 ± 0.01, p = 0.042722); serum bilirubin level in group 1 was statistically significantly lower compared to group 2 (33.4 ± 9 and 39.8 ± 3.4 μmol/l, respectively, p = 0.0377); serum transaminases, alanine aminotransferase and aspartate aminotransferase, were statistically significantly lower in group 1 compared with group 2 – alanine aminotransferase – 50 ± 3.3 and 78.6 ± 8.2 U/l, respectively (p = 0.0022), aspartate aminotransferase – 42 ± 2.9 and 62.4 ± 8.9 U/l, respectively (p = 0.0282)).Conclusions. With the dominant type of middle hepatic vein in transplants of the right lobe, it is necessary to perform the right lobe of the liver with the middle vein. If the right vein is dominant – the right lobe of the liver without the inclusion of the middle vein. Adequate venous outflow, with a sufficient volume of the graft of the right lobe of the liver, determines the functional mass of the graft.
不同类型的静脉流出重建对肝移植肝血流及功能状态的影响尚未得到充分的研究。在活体家庭捐赠中,具有最佳血流特性的移植物是决定其功能状态的关键因素之一。的目标。活体供体右肺叶移植后肝脏局部血流动力学及血液生化指标的比较。材料和方法。根据我们的算法,包括分析供体肝静脉的变异解剖,以确定优势静脉的类型,选择76例受者进行移植:39例(1组)移植右叶中静脉,37例(2组)移植右叶不移植中静脉。为了进行比较分析,我们采用血液生化参数和移植物区域血流动力学数据:两组移植后第1周及移植后第10、14、21、30天肝动脉门静脉血流容量、线速度和阻力指数。采用所描述的移植物选择算法,我们在移植后第30天得到以下结果:在观察的各个阶段,1组门静脉血流容量均高于2组(1110±62 ml/min和922±41 ml/min, p分别为0,013864);2组肝动脉阻力指数为0.61±0.01,高于1组(0.63±0.01,p = 0.042722);1组血清胆红素水平显著低于2组(分别为33.4±9、39.8±3.4 μmol/l, p = 0.0377);血清转氨酶、丙氨酸转氨酶和天冬氨酸转氨酶,1组与2组比较,分别为- 50±3.3和78.6±8.2 U/l (p = 0.0022)、- 42±2.9和62.4±8.9 U/l (p = 0.0282),差异有统计学意义。由于右肝叶移植以肝中静脉为主,因此采用肝中静脉进行右肝叶移植是必要的。如果右静脉占主导地位-肝右叶不包括中间静脉。充足的静脉流出量和肝右叶移植物的足够体积决定了移植物的功能质量。
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引用次数: 0
Analysis of the stages of psychological preparation of transplant coordinators (as part of the implementation of the bulk program) 移植协调员心理准备阶段分析(作为批量项目实施的一部分)
Pub Date : 2020-12-16 DOI: 10.30702/TRANSPAORG/10_20.0112/126-129/089.843
A. P. Poplavskaya
This article presents an analysis of the stages of psychological training of future transplant coordinators within the framework of the implementation of the first ZMAPO Transplant Coordinator Program. The introduction of the newly developed program for the training of future transplant coordinators has reflected some of the complexities of the psychological and pedagogical process: first, a lack of purely psychological knowledge and skills, certain problems of mastering new theoretical material, certain difficulties in overcoming barriers to communication. But all this was offset by a desire to get new interesting information, a desire to learn something new, and to develop skills for direct dialogue with potential donors and their relatives.
本文介绍了在实施第一个ZMAPO移植协调员计划的框架内对未来移植协调员的心理训练阶段的分析。引进新开发的培训未来移植协调员的方案反映了心理和教学过程的一些复杂性:首先,缺乏纯粹的心理知识和技能,掌握新的理论材料方面存在某些问题,在克服沟通障碍方面存在某些困难。但是,所有这些都被获得新的有趣信息的愿望所抵消,渴望学习新的东西,并发展与潜在捐赠者及其亲属直接对话的技能。
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引用次数: 0
Mechanical Circulatory Support in Patients with End-Stage Heart Failure 终末期心力衰竭患者的机械循环支持
Pub Date : 2020-12-16 DOI: 10.30702/TRANSPAORG/02_20.0112/018-039/089
V. Tanskyi
Objective. The aim of the study is to establish the effectiveness of mechanical support of blood circulation of patients with end-stage heart failure depending on the method of surgical correction. Materials and methods. The results of the study are based on the data of examination and dynamic observation of 73 patients (median age 44 (16-69) years, 68 men, 5 women) who were treated from 2008-2019 іn the following medical institutions: Republican Scientific and Practical Center «Cardiology» (Minsk, Republic of Belarus) and Center of cardiac surgery on the basis of Hospital «Feofania». Patients were examined during the initial examination, after 3 months and after 1 year. Results and discussion. As a result of the study found, indications for surgical treatment of patients with end-stage heart failure those are the following criteria: left ventricular ejection fraction (LV EF) <20%, (p < .0001). Pulmonary artery occlusion pressure (PAL) from 25 mm Hg up to 35 mm Hg (p < .0001). Peak myocardial oxygen consumption <14 ml/kg/min on the background of maximum drug therapy (p < .0001). Pulmonary vascular resistance (PVR) <5 units by Wood, (p < .0001). Transpulmonary gradient up to 15 mm Hg (p < .0001). Indications for LVAD therapy are the following criteria: left ventricular ejection fraction (LV EF) <20%, (p <0001). Pulmonary artery occlusion pressure > 35 mm Hg (p < .0001). Pulmonary vascular resistance (PVR) >5 units by Wood, (p < .0001). Transpulmonary gradient >15 mm Hg (p < .0001). Against the background of work LVAD after 3 months there was a decrease in the left ventricular cavity by 30%, (p < .0001), decrease in the pancreatic cavity by 25.5%, (p < .0001), increase in fraction LV emission by 21%, (p < .0001). According to direct pulmonary arterial tonometry with LVAD therapy, there was a decrease in pulmonary vascular resistance «Wood» by 34%, (p < .0001), reduction in pulmonary arterial pressure by 24%, (p < .0001), a decrease of transpulmonary gradient by 21%, (p < .0001). The results of the change in functional indicators in patients on LVAD therapy after 3 months: increase maximum myocardial oxygen consumption by 6% (p < .0001), increase exercise tolerance by 15% (p < .0001). Indications for BiVAD-therapy are the following criteria: biventricular insufficiency, (p < .0001). Pulmonary artery occlusion pressure >35 mm Hg, (p < .0001). Pulmonary vascular resistance >5 units by Wood, (p < .0001). Transpulmonary gradient >15 mm Hg, (p < .0001). Against the background of BiVAD work in 3 months was noted reduction of the right ventricular (RV) enddiastolic volume (EDV) by 6% (p <0001), reduction of the RV end-systolic volume (ESV) by 10%, (p < .0001), increase in LV EF by 33%, (p < .0001), decrease in left ventricular (LV) ESV (M-mode) by 36.3%, (p < .0001), a decrease in LV EDV (M-mode) by 30%, (p < .0001), a decrease in LV ESV (B-mode) by 22.5%, (p < .0001), increase in tricuspid systolic excursion (TAPSE) by 21.4%, (p < .0001). According to t
目标。该研究的目的是建立机械支持终末期心力衰竭患者血液循环的有效性取决于手术矫正的方法。材料和方法。研究结果基于2008-2019年间在以下医疗机构接受治疗的73名患者(中位年龄44岁(16-69岁),68名男性,5名女性)的检查和动态观察数据:共和国科学和实践中心«心脏病学»(明斯克,白俄罗斯共和国)和心脏外科中心«Feofania»医院。患者分别在初次检查、3个月后和1年后进行检查。结果和讨论。由于研究发现,手术治疗终末期心力衰竭患者的指征有以下标准:左心室射血分数(LV EF) 35 mm Hg (p < 0.0001)。肺血管阻力(PVR) Wood >5个单位(p < 0.0001)。经肺梯度>15 mm Hg (p < 0.0001)。在工作LVAD背景下,3个月后左心室腔减少了30% (p < 0.0001),胰腺腔减少了25.5% (p < 0.0001),左心室放射分数增加了21% (p < 0.0001)。根据LVAD治疗的直接肺动脉压计,肺血管阻力«Wood»降低了34% (p < 0.0001),肺动脉压降低了24% (p < 0.0001),经肺梯度降低了21% (p < 0.0001)。LVAD治疗3个月后患者功能指标变化结果:最大心肌耗氧量增加6% (p < 0.0001),运动耐量增加15% (p < 0.0001)。bivad治疗的适应症是以下标准:双心室功能不全(p < 0.0001)。肺动脉闭塞压>35 mm Hg, (p < 0.0001)。肺血管阻力Wood >5个单位(p < 0.0001)。经肺梯度>15 mm Hg, (p < 0.0001)。BiVAD工作在3个月的背景下,指出减少右心室(RV) enddiastolic卷(类别)6% (p < 0001),减少RV收缩末期容积(ESV) 10%, (p <。),LV EF增加33%,(p <。),减少左心室(LV) ESV (M-mode) 36.3%, (p <。),LV产品类别(M-mode)下降了30%,(p <。),减少LV ESV (b型)的22.5%,(p <。),三尖瓣收缩游览(TAPSE)增加21.4%,(p <。)。根据使用bivad治疗期间的直接肺动脉张力测量:肺血管阻力«Wood»降低22%,(p < 0.0001),肺动脉压降低15%,(p <0001),经肺梯度降低14%,(p <0001)。危重心衰患者的外科治疗结果:直接原位心脏移植(OHT)后:24例治疗阳性(92%),2例死亡(8%)。有18例患者进行了继发性OHT,其中接受LVAD治疗的患者(46%)。18例患者(46%)继续lvad治疗。lvad治疗组死亡3例(8%)。死亡原因是脓毒性病变。哪些患者接受了bivad治疗:继发性OHT 4例(50%)。4例患者(50%)在bivad治疗中死亡。死亡原因2例为脓毒性病变(50%),2例为多系统脏器功能衰竭(50%)。心衰患者NYHA功能分级III-IV类手术治疗差异结果分析:危重心衰患者存在直接心脏移植禁忌症时,可考虑在LVAD治疗(p < 0.0001)和bivad治疗(p < 0.0001)的基础上,采用长期机械循环支持作为心脏移植的机械桥接。对肺动脉高压高指标患者应用长期血液循环机械支持(p < 0.0001),可在短时间内(4-6周)使肺动脉压正常化,并考虑进行二次心脏移植。
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引用次数: 0
Replacement of Mandible Defect by a Rib Autotransplant 自体肋骨移植替代下颌骨缺损
Pub Date : 2020-12-16 DOI: 10.30702/TRANSPAORG/06_20.0112/078-088/035
N. Barannik, O. O. Mosieyko, O. M. Manukhina, A. Sidoryako, K. P. Volchykhina
Aims. Improve the technique of bone plastics of the mandible with a free autogenous rib graft.Materials and methods. A retrospective analysis of 41 case histories of patients undergoing surgical treatment in connection with the replacement of the mandibular defectsacquired due to tumors, injuries, osteomyelitis at the clinic of maxillofacial surgery in 2003-2018 was carried out. The technique of osteoplasty of the mandible with free autogenous rib graft has been improved by expanding the technical possibility of reliable fixation of bone fragments with titanium plates and screws, as well as tight installation of autograft in the bone defect and creating favorable conditions for the primary osseointegration. The own method of harvesting and formation of autogenous rib graft is proposed. For 15 years, not a single complication was identified and there was no rejection of the free autogenous rib grafts.Conclusions. This technique is simple, safe, and can be effectively used to reconstruct long-span mandibular defects with minimal complications in selected patients.    
目标自体肋骨游离移植改进下颌骨骨整形技术。材料和方法。回顾性分析2003-2018年颌面外科临床因肿瘤、损伤、骨髓炎所致下颌缺损行手术置换的41例患者的病史。下颌骨自体游离肋骨成形术技术的进步,扩大了用钛板和螺钉可靠固定骨碎片的技术可能性,并使自体骨瓣在骨缺损处安装紧密,为初次骨融合创造了有利条件。提出了一种自体肋移植的收获和形成方法。15年来,没有发现一例并发症,也没有出现自体肋骨游离移植的排斥反应。该技术简单,安全,可有效地用于重建长跨下颌骨缺损,并发症最小。
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引用次数: 0
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Transplantation and artificial organs
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