原位心脏移植(7例报告)  

Orthotopic Heart Transplantation(Report of 7 Cases)

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

机构地区：[1]广东省人民医院心外科,广东广州510100 [2]广东省人民医院心内科,广东广州510100

出　　处：《中山大学学报（医学科学版）》2006年第1期117-118,F0003,共3页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省重点科技攻关基金资助项目(9606)

摘　　要：目的总结7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2005年4月施行7例原位心脏移植,7例均为心肌病,其中5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3例,供心平均冷缺血时间为(167.4±22.1)min,术后定期行心内膜活检,使用四联免疫抑制剂。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5例至今存活,至今存活时间分别为6年9个月、5年6个月、1年7个月、10个月、3个月。结论心脏移植是治疗终末期心脏病的有效手段,处理好术后并发症,密切监测和处理排斥反应,能取得良好的近远期疗效,长期生存病例需特别注意慢性排斥反应的发生。[Objective] To summarize the experiences of orthotopic heart transplantation in 7 cases and explore the short-term and long-term effect of heart transplantation. [ Methods ] Seven patients underwent orthotopie heart transplantation from October 1998 to April 2005. Dilated and constricted eardiomyopathy were diagnosed in 5 eases and 2 eases respectively. The procedure included Stanford orthotopic heart transplantation in 4 cases and bieaval heart transplantation in 3 eases. The average cold isehemie time of donor heart was （167.4±22.1）min. All underwent regular endocardium biopsy and were treated with 4 combined immunosuppressive agents postoperatively. [Results] The 1^th ease survived for 5 days, died of the complication of low cardiac index and intra-aortic balloon pump, the forth ease survived for 18 months, died of the complication of mild to severe, combined acute and chronic rejection. The other 5 cases got prolonged survival with good quality of life, the survival was 81 months, 66 months, 19 months, 10 months,3 months respectively. [Conclusion] Heart transplantation is an effective method to treat end-stage heart disease. Improved short-term and long-term effect of treatment relies on good management of postoperative complication and meticulous monitoring and treatment of acute rejection. Chronic rejection must be monitored in long term survival eases.

关 键 词：心脏移植 心肌病 排斥反应 

分 类 号：R654.2[医药卫生—外科学]