同种异体原位心脏移植术临床研究  

Clinical Study of Orthotopic Heart Transplantation

作　　者：王东[1] 刘天起[1] 马延平[1] 王明华[1] 李培杰[1] 刘鲁祁[1] 李敏[1] 许莉[1] 张辉[1] 

机构地区：[1]山东省千佛山医院,济南市250014

出　　处：《医药论坛杂志》2010年第22期126-127,131,共3页Journal of Medical Forum

摘　　要：目的研究同种异体原位心脏移植术治疗终末期心脏病过程中的经验教训,以进一步提高治疗效果。方法为20例终末期心脏病患者施行原位心脏移植术,其中采用标准原位心脏移植术1例,双腔静脉吻合法原位心脏移植术19例,其中心肾联合移植1例。术中及术后给予一氧化氮(NO)吸入及静脉持续泵入前列环素,降低肺动脉压预防右心功能不全。手术应用巴利昔单抗及大剂量甲基强的松龙(MP)预防急性排斥反应。术后常规抗排斥治疗采用环孢素A(CsA)与泼尼松(Pred)加霉酚酸酯(MMF)三联方案。肾功能不全患者延迟时间应用CsA。结果 3例术后出现急性排斥反应,给予大剂量MP冲击治疗3d缓解;1例术后第3d出现肾功能衰竭,给予血液透析;早期霉菌感染2例。早期死亡2例,1例为术后25h上消化道出血;1例为心肾联合移植术后18d发生肺动脉栓塞。随访1~84个月,晚期死亡2例,1例为术后35d肾功能不全及抗排斥药物神经毒性反应所致;1例为术后46d感染性休克死亡。存活病例心功能恢复至Ⅰ~Ⅱ级(NYHA分级),恢复正常工作和生活。结论严格掌握受体适应证、合适的手术方法及合理的围术期管理是提高同种异体原位心脏移植术疗效的关键。Objective To explore the experience of orthotopic heart transplantation and to improve the therapeutic effect.Methods Totally 20 patients with end-stage cardiomyopathy were treated with orthotopic heart transplantation,including a case of dilated cardiomyopathy,1 patient received conventional stanfordcardiac transplantation and 19 patients received bicaval anastomotic cardiac transplantation and 1 patient with combined heart and kidney transplantation（CHRT）.The patients with pulmonary hypertension were treated with inhalation of NO and continuous pumping into the Prostacyclin during and after operation,which could reduce pulmonary artery pressure to prevent right cardiac dysfunction.To prevent acute rejection,Basiliximab and high-dose Medrol were used.All cases were prescribed with Cyclosporine A＋Corticosteroids＋MMF.Results 2 patients died in an early post-operative stage,1 of which died at 25 hours after operation for upper gastrointestinal hemorrhage;another patient with heart and kidney transplantation died at 18th day for thrombus of pulmonary.During 1~84 months follow-up,2 patients died in the later stage,1 of which died at 35th day for renal insufficiency and neurotoxicity of anti-rejection drug,another died at 46th day for infectious shock.The heart function of the survived patients recovered to level I^II（NYHA）.Conclusion The operative result of heart transplantation can be improved by accurate selection for recipient,suitable surgical procedure and accurate management of peri-operation.

关 键 词：扩张型心肌病 肥厚型心肌病 缺血性心肌病 心脏移植 心肾移植 

分 类 号：R654.2[医药卫生—外科学]