同种异体原位心脏移植的临床研究(附5例报道)  

Clinical research of Orthotopic heart transplantation(Report of 5 cases)

作　　者：吴若彬[1] 张镜芳[1] 林曙光[2] 肖学钧[1] 杨小慧[1] 陈纪言[2] 郑少忆[1] 范瑞新[1] 卢聪[1] 陈伟达[1] 罗沙[1] 黄克力[1] 

机构地区：[1]广东省人民医院广东省心血管病研究所心外科,广州市510100 [2]广东省人民医院心内科

出　　处：《岭南心血管病杂志》2004年第4期250-252,共3页South China Journal of Cardiovascular Diseases

基　　金：广东省重点科技攻关项目 (编号 :外 960 6)

摘　　要：目的　总结 5例心脏移植经验 ,探讨心脏移植的近远期疗效。方法　 1998年 10月至 2 0 0 3年 12月施行5例原位心脏移植 ,5例均为心肌病 ,其中 3例为扩张型 ,2例为限制型 ,手术方法采用标准法 4例、双腔静脉法 1例 ,供心平均冷缺血时间为 (16 5 .6± 2 6 3)min ,术后定期行心内膜活检 ,使用 4联免疫抑制剂。结果　第 1例存活 5d ,死于低心排及主动脉内球囊反搏 (IABP)的并发症 ,第 4例存活 18月 ,死于中———重度的急、慢性并存的排斥反应 ,余 3例至今存活 ,至今存活时间分别为 5年 8个月、4年 5个月、6月。结论　心脏移植是治疗终末期心脏病的有效手段 ,充分的术前准备 ,良好的心肌保护 ,合理使用免疫抑制剂 ,能取得良好的近远期疗效 ,长期生存病例需注意慢性排斥反应。Objectives To review the experience of orthotopic heart transplantation in 5 cases, and to discuss the short-term and long-term effect of treatment. Methods Between October 1998 and December 2003,5 patients, 3 with diagnosis of dilated cardiomyopathy and 2 constricted with cardiomyopathy. The operative procedures included 4 conventional Stanford orthotopic cardiac transplantation and 1 bicaval anastomotic cardiac transplantation. The donor heart cold ischemic time was(165.6±26.3) min. Regular endocardium-myocardial biopsy, the 4 comined immunosuppressive agents treatment was used.Results The first casesurvived for 5 days, died of the complication of LOCS and IABP, the fourth case survived for 18 months, died of the complication of mild to severe,acute and chronic combined rejection reaction. Another 3 cases got prolonged survival with good quality of life, the survival time was 5 years and 8 months, 4 years and 5 months, 6 months respectively. Conclusions Heart transplantation is a very effective treatment for end-stage heart failure, the success of it was contributed to the fully preoperative preparation, better myocardial protection and rational use of immunosuppressants, can gain good short-term and long-term effect of treatment. The cases with long term survival need considering the chronic rejection reaction.

关 键 词：同种异体原位心脏移植 心肌病 排斥反应 手术方法 

分 类 号：R654.2[医药卫生—外科学]