存活十年以上同种原位心脏移植三例  

Three cases of orthotopic heart transplantation surviving more than 10 years

作　　者：姚志发[1] 田海[1] 张临杰[1] 田伟忱[1] 蒋树林[1] 祁家驹[1] 陈子道[1] 夏求明[1] 

机构地区：[1]哈尔滨医科大学附属第二医院心外科,150086

出　　处：《中华器官移植杂志》2007年第5期261-264,共4页Chinese Journal of Organ Transplantation

摘　　要：目的总结同种原位心脏移植后患者获得长期存活的临床治疗经验和体会。方法为2例扩张性心肌病和1例慢性克山病患者施行心脏移植,术前患者的肺动脉压力为42～53 mm Hg (5.60～7.07 kPa),肺血管阻力为5.6～7.0 wood。供、受者体重相差10%～15%,HLA配型有3个抗原相同。供心采用含钾温血经冠状静脉窦连续逆行灌注。2例采用标准法心脏移植,1例采用全心法心脏移植,心房及大血管均采用外翻缝合法。术后应用环孢素A、硫唑嘌呤及皮质类固醇激素预防排斥反应。结果3例患者术后存活时间分别为13年10个月、12年及10年3个月,患者心功能NYHA分级为Ⅰ级,均恢复正常生活和工作。3例术后分别发生6、3、1次排斥反应,经治疗逆转。心电图检查显示,例1、例2有2个P波,例3为正常窦性心律。超声心动图显示,例1、例2有左、右心房增大,三尖瓣轻度返流.例3各心腔大小正常,无二尖瓣、三尖瓣返流。3例术后经4～9次冠状动脉造影,均未发现异常。结论选择合适的供、受者,保护好供心,采取恰当的术式和吻合技术,合理应用免疫抑制剂以及预防心脏移植物血管病,是关系心脏移植患者长期存活的重要因素。Objective To summarize the experience of long-term survival of the patients undergoing orthotopic heart transplantation. Methods Heart transplantation was performed on 2 cases of dilated cardiomyopathy and one case of Keshan disease. Before operation, pulmonary artery pressure was 42-53 turn Hg （5. 60-7. 07 kPa） and pulmonary vascular resistance 5. 6-7. 0 wood, The body weight difference between donors and receptors was 10%-15 %. There were three same antigens in HLA zygosity experiment for all of three patients. Two cases were subjected to standard heart transplantation and one case to whole heart transplantation. All the atriums and big vessels were sutured by evting suture method. Cyclosporin A, azathioprine and corticosteroid were used to prevent patients from rejection. Results Survival time of 3 patients was 13 years and 10 months, 12 years and 10 years and 3 months, Heart functions of three patients were NYHA Ⅰ and all of 3 patients are living and working commonly. Six,3 and 1 rejection（s） occurred in 3 patients respectively and cured by appropriate treatment. Electrocardiogram revealed that case 1 and case 2 had two P waves and case 3 sinus rhythm. Ultrasonic cardiogram showed that in case 1 and case 2, the left and right atriums were enlarged and tricuspid valve had slight backstreaming, and in case 3, all of the cardiac chambers were normal and had no backstreaming of tricuspid valve and mitral valve. No abnormal findings were found in 3 cases by 4-9 times of coronary arteriongraphy. Conclusion The important factors for the patients＇ long-term survival after heart transplantation include the choice of appropriate donors and acceptors, protection of donors＇ hearts, selection of appropriate operations and suture methods, rational use of immunosuppressants and prevention of cardiac allograft vasculopathy.

关 键 词：心脏移植 幸存患者 原位移植 

分 类 号：R654.2[医药卫生—外科学]