How does heart transplant surgery work? - Roni Shanoada

3,221,562 views ・ 2022-05-24

TED-Ed


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譯者: Wei C. 審譯者: Bruce Sung
00:07
Your heart beats more than 100,000 times a day.
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你的心臟一天跳動超過十萬次
00:11
In just a minute, it pumps over five liters of blood throughout your body.
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僅僅一分鐘內, 它抽送超過五公升的血液流過全身
00:17
But unlike skin and bones, the heart has a limited ability to repair itself.
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但不像是皮膚與骨骼, 心臟的自我修復功能相當有限
00:22
So if this organ is severely damaged,
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所以若是損傷太嚴重
00:25
there’s often only one medical solution: replacing it.
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通常就只有一種醫治方法: 更換它
00:30
Today, nearly 3,500 heart transplants are performed each year
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如今,一年內會執行 將近 3500 個心臟移植手術
00:35
in a complex and intricate procedure with no room for error.
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這是道複雜且精密的程序, 絕不容許出錯
00:40
The process begins by testing potential recipients
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過程開始首先會測試可能的接受者
00:44
to ensure they’re healthy enough for this demanding operation.
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確保他們足夠健康 得以接受嚴苛的手術
00:49
Doctors are especially concerned with identifying immunocompromising illnesses
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能辨認出免疫功能低下的疾病 對醫生而言十分重要
00:54
or any other conditions that could compromise a patient's chance of survival.
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或是任何可能危及病患存活的病狀
00:59
The next step is to match an eligible recipient with a heart donor.
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下一步便是將心臟捐贈者 配對到一個合格的接受者
01:04
Donors are often comatose patients with no chance of being resuscitated
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捐贈者通常都是 沒有機會甦醒的昏迷病患
01:09
or victims of a fatal event whose hearts are still healthy.
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或是經歷了致命事故 但有健康心臟的受害者
01:14
In both cases, these patients need to be registered as an organ donor
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在這兩種情形之下, 這些病患須被登記為器官捐贈者
01:18
or have their families give consent.
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或是取得其家人同意
01:21
And even when a heart is available,
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即使有可用的心臟時
01:23
surgeons can’t just pair any donor with any recipient.
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外科醫師也不能 隨意配對捐贈與接受者
01:27
The recipient’s immune system will view a transplanted heart
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接受者的免疫系統會將移植的心臟
01:31
as a foreign organism that must be attacked.
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視為外來有機體並對其發動攻擊
01:35
So doctors need to match recipients with donors that share their blood type
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所以醫生必須將有相同血型
01:40
and have similar antigens.
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和抗原的接受者配對
01:42
If a match can be made, the surgery can begin.
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若配對成功, 手術便可開始進行
01:45
Once the donor's heart is confirmed to be healthy,
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一旦確認了捐贈者心臟是健康的
01:49
the organ is immersed in an ice slush
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器官會被埋進碎冰中
01:51
and injected with a solution to induce cardiac arrest.
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並注入一種能引起心臟停搏的藥劑
01:56
These treatments stop the heart from pumping
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這些步驟能讓心臟停止跳動
01:58
to ensure it can be removed cleanly.
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以確保它能被乾淨地移除
02:01
Surgeons then place the organ in a mix of cold saline
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外科醫生接著會把器官放入 冰生理食鹽水
02:05
and preservation solution.
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與保存溶液的混合液中
02:08
This is when the clock starts.
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這時候時間就十分寶貴了
02:10
Disconnected from its blood supply,
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斷開心臟的血液供應後
02:12
the heart’s cells start taking on damage from lack of oxygen.
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心肌細胞會開始因缺氧而受損
02:16
The organ will only remain viable outside the body for a few hours,
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這個器官僅在體外的幾小時中存活
02:20
so it needs to reach its recipient as fast as possible.
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所以必須越快送給接受者越好
02:24
Once the heart arrives, the recipient is put under general anesthesia.
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一旦心臟送達, 接受者將接受全身麻醉
02:29
The surgeon makes an incision down the length of the chest,
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外科醫生會沿胸腔做一個切口
02:33
cutting through the breastbone to separate the rib cage
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切開胸骨並分離胸廓
02:36
and expose the heart.
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然後暴露出心臟
02:37
To keep blood flowing while they remove the damaged organ,
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為確保在移除受損器官時 能維持血流
02:40
surgeons use a cardiopulmonary bypass machine.
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外科醫生會使用心肺體外循環機
02:44
This takes over the heart's job,
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來接管心臟的工作
02:46
generating enough force to push blood through the patient's circulatory system.
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產生足夠的力將血液
推送過病人全身的循環系統
02:52
After the old heart is removed,
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當舊心臟被移除後
02:54
the surgeon begins sewing the donor heart into place.
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外科醫生開始縫上捐贈的心臟
02:58
This is an incredibly precise process, where each blood vessel and artery
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這是極度精密的過程, 每條血管與動脈
03:02
must be carefully attached to avoid leaks.
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都必須小心的接合, 以避免溢漏
03:07
The procedure can last several hours,
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手術過程會持續上數小時
03:09
potentially longer if there’s scar tissue from previous surgeries.
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如果之前的手術產生疤痕組織 可能會花更久時間
03:13
Once it’s finished, the bypass machine is turned off
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手術完成後, 體外循環機會關閉
03:16
and blood is allowed to flow into the aorta.
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而血液便可開始流入主動脈
03:20
Doctors carefully monitor the new heart to ensure it’s beating on its own
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醫生會小心地監控 確保新的心臟是靠自己跳動之後
03:24
before sewing the recipient back up.
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才將接受者縫合
03:27
Even after the procedure is complete, there's still work to be done.
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即使在手術完成之後, 還是有些工作待進行
03:31
Surgeons are unable to directly connect the heart
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外科醫生無法直接將心臟
03:34
to the recipient’s nervous system,
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連接到接受者的神經系統
03:36
and it can take years for the body to fully innervate the new organ.
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故可能得花上數年 來使身體將器官完全接上神經
03:42
During this period, the transplanted organ has a higher resting heart rate
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在這期間, 移植心臟會有較高的靜止心率
03:47
and risk of stroke, making exercise difficult and dangerous.
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與中風的風險, 讓運動變得困難且危險
03:51
And since it’s incredibly rare to find a perfect match
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而又因為在捐贈者與接受者之間
03:54
between donor and recipient,
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找到完美匹配的器官非常罕見
03:56
the immune system will also have some response to the new heart.
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免疫系統也會對新心臟做出反應
04:00
Immunosuppressive drugs can help manage the risk of rejection,
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免疫抑制藥物可以降低排斥的風險
04:04
but they also leave patients open to contracting dangerous infections.
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但也可能讓病患容易得到嚴重感染
04:09
It requires constant monitoring and testing to balance these two concerns.
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這都需要持續的監測與檢查 來平衡兩者
04:14
Despite these challenges, about 70% of heart transplant recipients survive
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儘管面臨許多挑戰, 有七成的心臟移植接受者
04:19
for at least five years after the operation,
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在手術後至少五年內存活
04:22
and just over 20% live another 20 years.
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而僅有超過兩成能再活 20 年
04:26
So when this procedure is successful, it's truly lifesaving.
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所以當手術成功時, 確實是能救人一命
04:30
Unfortunately, people in developing countries are often unable
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不幸地是, 生活在發展中國家的人
通常無法進行這種手術
04:33
to access this surgery,
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04:35
and many viable hearts can’t be donated due to legal and regulatory issues.
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因為法律規範問題, 眾多有效的心臟無法捐贈
04:41
Thousands of people remain on waiting lists,
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數千人仍在等待名單上
04:44
and many are never able to find a suitable donor.
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而許多人甚至無法找到 合適的捐贈者
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