ISSN 2097-6046（网络）
ISSN 2096-7446（印刷）
CN 10-1655/R
主管：中国科学技术协会
主办：中华护理学会
中华急危重症护理杂志

中华急危重症护理杂志 >

2026 , Vol. 7 >Issue 6: 682 - 684

DOI: https://doi.org/10.3761/j.issn.2096-7446.2026.06.007

心脏手术康复护理专题

边缘供心心脏移植术后患者原发性移植物功能障碍的早期预警与护理

  • 张慧 ,
  • 何雪花 ,
  • 王莉 ,
  • 宫晓艳 ,
  • 庄一渝
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  • 浙江大学医学院附属邵逸夫医院护理部 杭州市 310000
张慧：女，本科（硕士在读），主管护师，E-mail：2611136@zju.edu.cn
第一联系人：

张慧：论文撰写；何雪花、王莉：个案选择和资料整理；宫晓艳、庄一渝：论文审阅和修改

*庄一渝，E-mail：zhuangyy@zju.edu.cn

收稿日期: 2025-09-14

  网络出版日期: 2026-06-02

基金资助

浙江省医院可持续发展扬子江研究项目(2024ZHA-YZJ210)

收起

Early warning and nursing intervention for primary graft dysfunction after heart transplantation using a marginal donor heart：a case report

  • ZHANG Hui ,
  • HE Xuehua ,
  • WANG Li ,
  • GONG Xiaoyan ,
  • ZHUANG Yiyu
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  • Nursing Department， Sir Run Run Shaw Hospital，Zhejiang University School of Medicine， Hangzhou 310000， China

Received date: 2025-09-14

  Online published: 2026-06-02

Supported by

Sustainable Development of Hospitals in Zhejiang Province-Yangtze River Research Project(2024ZHA-YZJ210)

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摘要

总结1例边缘供心心脏移植术后患者并发原发性移植物功能障碍的护理体会。护理要点：基于边缘供心特征的护理主导型早期预警，快速启动静脉—动脉体外膜肺氧合联合持续肾脏替代治疗，实施基于血流动力学动态评估的分阶段精准容量滴定管理；并应用基于床旁电阻抗成像可视化监测的右心保护通气策略。患者术后第16天转出ICU，第22天康复出院。

关键词： 体外膜氧合作用; 边缘供心; 原发性移植物功能障碍; 心脏移植; 危重病护理

本文引用格式

张慧 , 何雪花 , 王莉 , 宫晓艳 , 庄一渝 . 边缘供心心脏移植术后患者原发性移植物功能障碍的早期预警与护理[J]. 中华急危重症护理杂志, 2026 , 7(6) : 682 -684 . DOI: 10.3761/j.issn.2096-7446.2026.06.007

Abstract

This report summarized the nursing experience of a patient who developed primary graft dysfunction （PGD） after heart transplantation using a marginal donor heart. Key nursing interventions included the implementation of a nurse-led early warning system based on the characteristics of the marginal donor heart，the rapid initiation of veno-arterial extracorporeal membrane oxygenation（VA-ECMO） combined with continuous renal replacement therapy（CRRT），the execution of phased and precise volumetric titration management according to dynamic hemodynamic assessments，and the implementation of a right heart-protective ventilation strategy guided by bedside electrical impedance tomography（EIT）-based visualization monitoring. The patient was successfully transferred out of the intensive care unit on postoperative day 16 and discharged on day 22.

Key words： Extracorporeal Membrane Oxygenation; Marginal Donor; Primary Graft Dysfunction; Heart Transplantation; Critical Care Nursing

参考文献

[1] Aissaoui N, Morshuis M, Maoulida H, et al. Management of end-stage heart failure patients with or without ventricular assist device:an observational comparison of clinical and economic outcomes[J]. Eur J Cardio Thorac Surg, 2018, 53(1):170-177.
[2] Bifulco O, Bottio T, Caraffa R, et al. Marginal versus standard donors in heart transplantation:proper selection means heart transplant benefit[J]. J Clin Med, 2022, 11(9):2665.
[3] Hull TD, Crowley JC, Villavicencio MA, et al. Primary graft dysfunction in heart transplantation:How to recognize it,when to institute extracorporeal membrane oxygenation,and outcomes[J]. JTCVS Open, 2021, 8:128-133.
[4] McMichael ABV, Ryerson LM, Ratano D, et al. 2021 ELSO adult and pediatric anticoagulation guidelines[J]. ASAIO J, 2022, 68(3):303-310.
[5] Arrigo M, Price S, Harjola V P, et al. Diagnosis and treatment of right ventricular failure secondary to acutely increased right ventricular afterload(acute cor pulmonale):a clinical consensus statement of the Association for Acute CardioVascular Care of the European Society of Cardiology[J]. EUR HEART J-ACUTE CA, 2024, 13(3):304-312.
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