心肺联合移植术治疗艾森曼格综合征  

Experience of Combined Heart-lung Transplantation for 2 Eisenmenger′s Syndrome Patients

作　　者：杨守国[1] 王春生[1] 陈昊[1] 洪涛[1] 庄亚敏[1] 张颖[1] 朱仕杰[1] 姜桢[1] 

机构地区：[1]复旦大学附属中山医院心外科,复旦大学器官移植中心,上海市心血管病研究所,上海200032

出　　处：《中国临床医学》2008年第5期588-589,共2页Chinese Journal of Clinical Medicine

基　　金：上海市教委"曙光计划"基金(2003);上海市重点学科建设项目(B116)

摘　　要：目的:总结2例同种异体心肺移植成功的临床经验。方法:2003年12月及2004年4月分别完成2例心肺联合移植术,受体均为女性,年龄分别为41岁及43岁;病因均为先天性心脏病房间隔缺损并Eisenmenger综合征;术前肺动脉压均>130mmHg,肺血管阻力>12 Wood U,心功能IV级。供体男性1例,女性1例,以4℃ UW液1000mL及HTK液4000mL保存供体心肺。移植术后严格消毒隔离,按赛尼哌+环孢素A+霉酚酸酯+激素的方案进行抗排斥治疗,用第3代头孢菌素预防感染。结果:2例患者全部存活,1例术后延迟拔气管插管。1例术后存活至今并随访4年8个月,早期并发白细胞减少,无严重感染或排斥反应发生;另1例术后1年死于肺部真菌感染。结论:良好的吻合技术、完善的心肺保存及术后严格的预防感染、合理的抗排斥治疗是心肺联合移植成功的重要因素。Objective： To summarize the successful experience for continuous two case heart lung transplantations performed at Zhongshan Hospital. Methods：Between December 2003 and April 2004, two female patients, with diagnosis of congenital atrial septal defect with Eisenmenger＇s syndrome, aged of 41 and 43 years, undertook homologous heart-lung transplantation at our center, preoperatively patients showed pulmonary artery pressure high above 130 mmHg, pulmonary vascular resistance high above 12 Wood Units and cardiac function of NYHA class IV. Donors included one male and one female, donor hearts and lungs were preserved with 1000ml 4℃ UW solution and 4000 ml HTK solution. Postoperative measures of disinfections were executed strictly. Immunosuppressive therapy and prophylaxis against infection were given with Zenapax ＋ Cyclosporine A ＋ Mycophenolate mofetil ＋ Corticosteroids and third-generation cephalosporin. Results： Both patients survived the operation; one patient was extubated at 7^th postoperative day. During the follow-up period, one patient survived till nowadays for 4 years and 8 months and suffered from leukopenia in early postoperative stage. No severe infection or rejection were complicated. The other patient died on 1 postoperative year for severe pulmonary fungus infection. Conclusion：Perfect operative techniques, improved donor organ preservations, strict preventive measures against infection and immunosuppressive management were key factors for heart-lung transplantation.

关 键 词：心肺移植 同种异体移植 艾森曼格综合征 

分 类 号：R541.1[医药卫生—心血管疾病]