心肌内心电图远程移动监测心脏移植术后急性排斥反应  

Long-distance IMEG Monitoring of Acute Rejection after Heart Transplantation

作　　者：王默[1] 吴树明[2] 唐慧[3] 庞昕焱[2] 金星[1] 吴学君[1] 

机构地区：[1]山东大学附属省立医院血管外科,山东济南250021 [2]山东大学齐鲁医院心脏外科,山东济南250012 [3]山东省疾病预防控制中心,山东济南250014

出　　处：《中国医学物理学杂志》2009年第3期1232-1235,共4页Chinese Journal of Medical Physics

基　　金：山东省卫生厅资助项目(No.2005hz055)

摘　　要：目的:心肌内心电图是一种无创且可连续监测急性排斥反应的方法,但在患者出院后,无法发挥其可连续监测的优势。心脏远程监护系统是远程医疗体系中较早开展的技术,已成功应用于临床,能远程监测心电异常。本研究旨在探讨心肌内心电图远程移动监测心脏移植术后急性排斥反应的可行性。材料与方法:2004年4月～2005年10月山东省行同种异体原位心脏移植患者中,3例进行了心肌内心电图远程移动监测。将心肌内心电图远程移动监测诊断的急性排斥反应结果与胸部X线片、体表心电图、心脏彩色多普勒超声心动图、心肌酶谱联合诊断结果进行对照,以判断IMEG远程移动实时监测心脏移植术后急性排斥反应的可行性。结果:无论患者在院内,还是出院后,IMEG参数均能及时、准确地传输到监护中心。3例患者中,有2例在心脏移植术后第8天至9天IMEG出现不同程度QRS波振幅下降,下降幅度分别为22%和23%,提示急性排斥反应发生。经治疗后QRS波振幅恢复正常,与联合诊断结果有很好的相关性。2例患者出院后继续保留心脏起博导线15天,1例患者于术后37天无症状型排异反应被及时诊断。结论:远程移动监护与IMEG的结合,充分发挥IMEG简便,无创伤,实时、可连续监测的优点,大大提高患者的生存质量和生存率。Objective： IMEG has been certified reliable in monitoring acute rejection ha our prevenient study. But the most distinguished advantage of IMEG, continuous monitoring, can＇t be maintained after patients were dismissed from hospital. This study is to evaluate the reliability of long-distance IMEG monitoring during episodes of acute rejection after heart transplantation. Methods： From April 2004 to Octobor 2005, 3 cases homogeneous orthotopic heart transplant were performed in two heart centers in our city. Acute rejection after transplantation was monitored by thoracic radiograph, body surface electrocardiogram, echocardiography, myocardial enzymogram, as well as IMEG using long-distance heart monitoring system. Results： Long-distance IMEG monitoring was completed successfully. Supported by GPRS mobile network, all IMEG information was transmitted forthwith to monitoring center in our hospital by iHolter3000, a cardiac electrophysiological monitor like traditional Holter. The voltage amplitude of IMEG QRS complex decreased 22% on the 8^th day after heart transplantation in one recipient, 23% on the 9^th day and 15% on the 37^th day in another, which were highly indicative of acute rejection that were verified by eombinative diagnosis of thoracic radiograph, body surface electrocardiogram, echocardiography and myocardial enzymogram. Conclusions： Long-distance IMEG monitoring is a continuous, real-time, sensitive, reliable and noninvasive procedure monitoring acute rejection after heart transplantation, which increases life quality and long-time survival of heart transplant patients for its early diagnosis of mild rejection without necessitating hospital admission.

关 键 词：心脏移植 急性排斥反应 无创监测 心肌内心电图 远程医疗 

分 类 号：R654.2[医药卫生—外科学]