心肺复苏对心脏移植预后的影响

Meysam Mojtabaee, F. Naghashzadeh, F. Ghorbani, Shahrzad Ghafarian, S. Shahryari, F. S. Beigee
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引用次数: 0

摘要

供体心脏短缺限制了心脏移植项目,而等待心脏移植的患者数量持续增加。优化所有可用供体心脏的使用是降低等候名单死亡率的关键。在不同的延长标准中,延长心肺复苏时间(CPR),即超过20分钟,一直被认为是供体选择的一个有争议的选择标准。本研究的目的是比较心肺复苏供者的心脏移植与不需要心肺复苏供者的心脏移植的结果。方法:本研究对伊朗德黑兰Masih Daneshvari医院2010 - 2019年成人心脏移植项目进行回顾性分析。研究人员调查了供体和受体的人口统计、终末期心脏病和脑死亡的原因、供体和受体的住院时间以及心肺复苏的持续时间和其他相关因素。质变量比较采用卡方检验。定量变量比较采用t检验。采用精算方法计算患者和移植物存活率,并采用Wilcoxon试验进行比较。结果:在92例受者中,39例移植了来自有心肺复苏症供者的心脏移植物。考虑CPR和非CPR移植,性别、年龄、供体和受体住院时间、早期排斥反应和1年生存率无显著差异。然而,我们发现心肺复苏术持续时间与3年生存率之间存在很强的负相关(P = 0.02, r值= -0.62),并且与移植后心律失常相关(P = 0.04)。结论:长时间cpr(特别是超过20分钟)可能对中期生存和移植后并发症产生负面影响。
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Impact of Cardiopulmonary Resuscitation on Cardiac Transplantation outcome
Introduction: Donor heart shortage limits heart transplantations programs while the number of patients waiting for cardiac transplant continues to increase. Optimizing the use of all available donor hearts is a vital key to reduce waiting list mortality. Among different extended criteria, prolong cardiopulmonary resuscitation (CPR), i.e. more than 20 min, has been considered under doubt to be a selection criterion in donor selection. The aim of this study was to compare the outcomes of heart transplantation from cardiopulmonary-resuscitated donors to those who received hearts from donors who did not require cardiopulmonary resuscitation. Methods: This study was a retrospective analysis of adult heart transplantation program in Masih Daneshvari Hospital in Tehran, Iran from 2010 to 2019. Donors and recipients’ demographics, cause of end-stage heart disease and brain death, duration of hospitalization for both donors and recipients and also the duration of cardiopulmonary resuscitation and other factors related to it were investigated. Qualitative variables were compared using Chi-square test. Quantitative variables were compared using T-test. Patient and graft survival rates were calculated using the actuarial method and compared using Wilcoxon's test. Results: Among 92 recipients, 39 were transplanted with cardiac grafts from CPR-suffering donors. There were no significant differences regarding sex, age, donor and recipient hospitalization periods, early rejection and 1-year-survival rate considering CPR and non-CPR grafts. However, we detected a strong negative correlation between the duration of CPR and 3-year-survival rate (P = 0.02 and R-value = -0.62) and also its association with post-transplant arrhythmias (P = 0.04). Conclusion: There is a negative possible influence of long-lasting CPRs (especially more than 20 minutes) in midterm survival and post-transplant complications.
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