超长时间离体心脏移植  

Preliminary Experiences of Successful Orthotopic Heart Transplantation with Overlong Time Isolated Heart

作　　者：张载高[1] 解水本[1] 薛志强[1] 赵哲[1] 贾群[1] 姜湘伟[1] 贝亚军[1] 

机构地区：[1]海军总医院心血管外科,北京100037

出　　处：《海军总医院学报》2005年第3期146-148,共3页Journal of Naval General Hospital of PLA

摘　　要：目的报道2例超长时间离体心脏移植早期结果。方法2例均男性,年龄32、24岁。诊断:终末期扩张性心肌病,心功能IV级。心脏超声心动图:左心室舒张期末径分别为91、83 mm,射血分数分别为24%、12.9%。手术行同种异体原位心脏移植术(双腔静脉法),供心用UW液经升主动脉灌注,放入盛有冰块的保温容器内运输。移植吻合时间为444、9 min,心脏离体时间为542min和367 min。围术期免疫抑制药用CD25单抗,后续治疗用环孢素、麦考酚吗乙酯和泼尼松方案。结果心脏自动复跳,窦性心律。术后呼吸循环基本平稳,除1例术后出现大量心包积液,经多次穿刺治愈外;其余无低心排综合征,无严重感染、心律失常和明显排异反应等并发症发生。随访2个月和4个月,心功能均恢复至Ⅰ级。超声测定左心室舒张期末径分别为46、49 mm,射血分数分别为54%、62%,各瓣膜无返流。结论有限病例提示,供体的正确获取、有效的心脏保存和心肌保护、双腔静脉吻合法,对离体较久的供体心脏仍有获得较好手术结果机会。对长期生存的影响有待进一步随访观察。Objective To summary the preliminary experience of 2 cases successful orthotopic heart transplantation with overlong time isolated heart. Methods Two cases of 32 and 25-year male patients were diagnosed as dilated cardiomyopathy with LVED 91 and 83mm, EF 24% and 12. 9%. The anastomotic times were 44 and 49 minutes. Isolated heart was stored at 4℃ in university of wisconsin solution （UW）for 542 and 367 mins. Results The two patients survived in the early operative period and there were no infection and rejection happened. During the 2 and 4 months follow-up the patient lived healthily and the cardiac function recovered from grad Ⅳ to Ⅰ （NYHA）, with LVED 46 and 49mm, EF 54% and 62%. Conclusion Patients with proper donor heart procurement and efficient heart preservation could achieve early satifactory results, but long-term results need further follow-up.

关 键 词：心脏移植 扩张性心肌病 心肌保护 

分 类 号：R654.2[医药卫生—外科学]