原位心脏移植临床经验(附10例报告)  

The experience of 10 heart transplantation

作　　者：姬尚义[1] 姚滨[1] 杨建安[1] 王小雷[1] 叶晓青[1] 刘志红[1] 陈伟新[1] 陈长春[1] 杨晓涵[1] 谭敏[1] 张艳辉[1] 张玉萍[2] 

机构地区：[1]深圳市孙逸仙心血管医院深圳市心血管疾病研究所,广东省深圳市518020 [2]深圳市保健办公室

出　　处：《中国心血管病研究》2006年第11期810-812,共3页Chinese Journal of Cardiovascular Research

基　　金：深圳市科技局计划项目(编号:200404130)

摘　　要：目的总结10例原位心脏移植经验,探讨该方法的近、远期疗效。方法10例心脏移植患者均为终末期扩张型心肌病,术前左室射血指数(EF)值10%～29%(21.2±3.3)%,10例患者术前均有频发室性早搏。5例患者用标准法,5例为双腔静脉法。供心热缺血时间2.6～6.7(4.2±1.0)min,冷缺血时间110～175(.141.2±16.3)min。抗排斥反应采用环孢素(CSA)+骁悉(MMF)+甲基泼尼松(Pred)三联方案。结果10例患者均在术后1～3个月内康复出院,出院时心功能均恢复到0～Ⅰ级。随访4.0～42.5(36.4±19.6)个月,晚期死亡2人,8人状况良好。结论原位心脏移植是治疗终末期心脏病的有效手段。做好供、受体的选择,血液配型及组织配型,尽量缩短热、冷缺血时间和术中良好的吻合,是手术成功的关键。术后抗排斥反应药物的应用和抗排斥反应的密切观察是取得远期疗效的重点。Objective To review the 10 cases of heart transplantation and to find out the early and late results. Methods 10 transplantation patients all are final stage of the dilated cardiomyopathy （DCM）. Pretransplantation EF were 10%-29% （21.2±3.3）. All 10 patients had frequently supraventricular beats.The anastomosis were standard in 5 cases and double vena cava in 5 patients. The donor heart had warm iscbemic time 2.6-6.7 （4.2±1.0）min and cold ischemic time 110-175 （141.2± 16.3）min. Cyclosporine A （CsA）,MMF,and methylprednisolone （prod） are used for cardiac rejection. The dose of CsA is adjusted to maintain blood through levels of 200 ng/ml. The rejection is diagnosed by clinical signs of heart failure,echocardiography,and ECG endomyocardial biopsy is still the most accurate. Results 10 patients are all survived from the operation and discharged from the hospital within 90 days. The heart function were recorved to grade 0-I. The follow-up time is 4.0-42.5 months（ 36.4±19.6 ）. All the patients are in good condition except one patient died at the eighth month because of the rejection. Conclusion The heart transplantation is efective for DCM. The keys for the transplant results are choosing appropriate candidate, better matching in ABO blood group and HLA between donor and recipient, shorting the ischemic time, and quality anas- tomosis. Cloosely follow-up is more importante for late survival,

关 键 词：心肌病 充血性 心脏移植 

分 类 号：R654.2[医药卫生—外科学]