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67次死里逃生 “护心接力”患者能下地行走啦

2019-04-23 22:45:30

  忻州开医药发票_电.┿.微‌136-4989-2070 ‌-蔡.先.生---σ‌σ【80460080】诚/信/合/作,100%保。真。售/后.保/障,长/期/有/效网传电竞归为体育竞赛?准确来说是归为体育竞赛表演
  
     “护心接力”患者能下地行走啦!
  心脏移植前 她曾67次死里逃生 
  3月29日,一颗由珠海志愿者捐献的珍贵心脏,“乘坐”救护车,在珠海、中山、佛山、广州四地交警的接力护送和沿途司机的礼让下,用时90分钟,跨越120公里,抵达位于广州的中山大学孙逸仙纪念医院南院区,顺利移植入严重心肌病患者钟阿姨的体内。
  4月15日上午,广州日报全媒体记者从医院获悉,55岁钟阿姨顺利地初步度过了术后的抗排斥关、抗感染关。心脏移植两天后即转出重症监护室,术后十一天拔除心包、纵隔引流管,如今已能下床活动。在家人的陪伴下,钟阿姨通过视频特意感谢好心的捐献者、社会各界以及医护人员对她的救助。
  中山大学孙逸仙纪念医院党委书记、心血管内科主任王景峰教授介绍,钟阿姨在等待心脏移植的过程中,曾67次遭遇心脏室速、室颤的“生死劫”,所幸在心内科、心外科等多学科协作团队的全力救治下,得以死里逃生,并最终重获“心”生。
  文/广州日报全媒体记者任珊珊 通讯员林伟吟、张阳
  图/广州日报全媒体记者王燕
  病情重:
  她67次死里逃生
  来自东莞的钟阿姨在今年1月突然晕倒意识丧失,后被确诊为“致心律失常性右室心肌病”。因反复室速、室颤发作,钟阿姨在当地医院治疗后,在体内植入了“埋藏式心律转复除颤器(ICD)”,在每一次心跳过快失去正常节律后,由ICD电击使心跳恢复正常。ICD记录显示钟阿姨共电击治疗65次。而其间就有发生“电风暴”的风险。据了解,在医学上,如24小时内发生超过三次的室性心动过速、心室颤动,被称为“电风暴”。
  原本设计使用寿命长达6~8年的ICD,植入钟阿姨体内仅1个多月,就耗尽了电池电量。当时钟阿姨转院到中山大学孙逸仙纪念医院,王景峰教授团队为钟阿姨更换了ICD,并转到医院心脏重症监护室治疗。然而,钟阿姨之后出现了两回“电风暴”。
  “ICD每一次放电,相当于一次心脏猝死后的抢救。而出现‘电风暴’的患者,有70%~80%的人会因为严重心律失常而死亡。” 王景峰教授解释,钟阿姨堪称67次死里逃生。
  出奇招:
  医生为“换心”争时间
  鉴于钟阿姨的病情十分严重,该院心内科、心胸外科等多学科团队联合会诊后,认为最适合的治疗方式是心脏移植。
  该院心胸外科主任郑俊猛教授介绍,心脏移植是一个复杂的治疗过程,术前、术中、术后这三个阶段都非常重要。但凡需要心脏移植的患者,手术前心脏的情况都非常糟糕,全身组织和脏器都处于低灌注状态,需要非常精细地去调整治疗方案,维护好各个脏器的功能使得患者安全过渡到心脏移植手术。
  然而,此时钟阿姨的情况已极为严重了。据该院心血管内科张殷殷副教授介绍,她反复出现躁狂、乱语等精神症状及呕吐现象,如不有效控制室速、室颤,不仅将再次导致ICD电池耗竭,更重要的是,将带来心功能恶化、感染及导致其他脏器功能衰竭,从而失去心脏移植的机会。
  常规的抗心律失常治疗方案并没有让钟阿姨的病情获得有效控制。王景峰教授决定打破常规,将四种不同机制的抗心律失常药物排列组合,创新性地分阶段联合用药。
  医生放手一搏出的“奇招”,果然奏效。从3月14日一直到3月29日,钟阿姨有15天没有出现心律失常,为等待心脏移植争取了宝贵的时间。
  护“心”车:
  90分钟跨越四城
  与此同时,心胸外科郑俊猛教授团队为钟阿姨在“中国人体器官分配与共享计算机系统”进行心脏移植等待登记,寻找最合适的心脏。
  3月29日上午,中国人体器官分配共享计算机系统为钟阿姨自动匹配到一个合适的供心。郑俊猛教授团队立即从医院南院区出发赶往珠海。
  返程时,载有“爱心”的粤A808NN救护车,获得珠海、中山、佛山、广州四地交警接力护送、沿途司机礼让的特殊待遇,在雨天只用了90分钟,便抵达位于广州海珠区盈丰路的中山大学孙逸仙纪念医院南院区。“爱心”抵达仅仅10分钟后,医院手术团队于18:00开始进行心脏移植。
  很“争气”:
  心脏在“新家”仅60分钟就独立“上岗”
  当晚11时许,捐献的心脏在“新家”里重新跳动。“那一刻大家如释重负,非常开心。”郑俊猛说,心脏复跳时,心脏还需要用体外循环机“扶上马,送一程”。医生慢慢调低机器的辅助功能,让心脏渐渐适应、承担起全身血液循环的重任。“此前有个病人,移植心脏复跳后,过了180分钟才适应。”郑俊猛说,钟阿姨移植的这颗心脏很“争气”,用了60分钟就适应了“新家”,独立“上岗”。
  经过5个小时25分钟,手术圆满结束。4月9日,新心脏在她的体内跳动11天时,拔除心包、纵隔引流管,开始下床活动。目前钟阿姨康复良好,还需要一个月的术后调理才可以出院。
  广州日报全媒体记者获悉,钟阿姨要终身服用抗排斥药。“手术后,一方面要用免疫抑制剂来降低机体对新心脏的排斥。另一方面,免疫力降低后,机体容易出现感染,也会威胁病人的安全。”郑俊猛表示,术后一年依旧有可能出现排斥和感染的反复,术后必须重视随访,维护好这颗来之不易的心脏。据了解,钟阿姨心脏移植的费用为50万元,目前抗排斥等药物可以由医保报销,但手术费用尚未被医保覆盖。
  来讨论
  “跨地送心”是社会资源浪费?
  质疑:这次跨越四地护送心脏,在媒体的直播下,引发舆论高度关注。据不完全统计,仅广州日报在新浪官方微博发起的“请为粤A808NN让行”的直播话题,在当天就有超过2800万次阅读量。但网上也有声音认为“跨城送爱心”消耗了较多社会资源。
  专家:“这次跨越四地护送捐献的心脏,是值得的。除了救回了钟阿姨这一个鲜活的生命,也让更多人关注到器官捐献的意义。”郑俊猛表示,心脏移植手术对器官离体保存的时间要求很高,如果能够就近捐献器官并完成移植手术,对病人、医疗团队当然更好,而实现这一愿景的前提是能有更多人捐献器官,就近传递“生命的礼物”,然而目前要实现这一目标,还存在各种困难。
  郑俊猛指出,实际上,无论国内外,公众都愿意对捐献器官的运输给予特别礼遇,这也反映了社会文明的进步。
  知多点
  “供心”需要多个学科的共同努力。
  记者获悉,目前广东省能开展心脏移植的医院有广东省人民医院、中山大学孙逸仙纪念医院、中山大学附属第一医院、广州医科大学附属第一医院。广州地区去年完成了60-70例心脏移植,全国则有400多例手术。
  郑俊猛表示,目前我国器官的获取主要来自“心死亡”及“脑死亡”捐献者,对于供心的获取只能是源自“脑死亡”捐献者,这也大大限制了供心的来源。对于需要接受心脏移植的成年患者,最佳的心源来自16岁~45岁捐献者的供心。


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