心肺联合移植中供者心、肺的保护及术后排斥反应的诊断和治疗二例  

Preservation of donor＇s heart and lung and discrimination and postoperative immunotherapy of graft rejection： a report of 2 cases of heart-lung transplantation

作　　者：殷胜利[1] 张希[1] 王治平[1] 刘云奇[1] 熊迈[1] 陈光献[1] 

机构地区：[1]中山大学附属第一医院心脏外科,广州510080

出　　处：《中华器官移植杂志》2011年第5期276-280,共5页Chinese Journal of Organ Transplantation

摘　　要：目的探讨心肺联合移植中供者心、肺的保护措施，以及术后免疫抑制方案、排斥反应的临床诊断及其处理。方法回顾分析2例心肺联合移植的临床资料。2例供肺的灌洗分别使用Perfadx保护液（每1000ml加入氨基丁三醇（）．3ml，伊洛前列素25／ag）和EuroCollins（EC）保护液（每10（）（）ml加入氨基丁三醇0．3ml，前列地尔100ug）。供心的灌洗使用uw液。心肺联合移植采用经典原位技术。免疫抑制方案采用巴利昔单抗诱导，术后采用环孢素A＋吗替麦考酚酯＋皮质激素。术后早期观察受者的血象变化，各器官功能，各心腔大小及室间隔、左室后壁厚度等，必要时行胸部CT、纤维支气管镜及组织病理检查，及时发现排斥反应征象。受者发生排斥反应后给予皮质激素冲击治疗，并及时调整免疫抑制剂用量。结果2例受者分别于术后第8（）天和第141天康复出院，分别随访4年6个月与4年2个月，现生活质量良好。1例受者于术后第10天和第26天发生急性排斥反应，另1例受者于术后第29天和第87天发生急性排斥反应，均经皮质激素冲击治疗，并调整免疫抑制剂用量后逆转。当受者发生急性排斥反应时，往往伴有血象的变化及室间隔和左心室后壁厚度的增加，给予相应治疗后渐恢复至正常范围。结论Perfadx保护液和EC保护液对供肺均有较好的保护作用，Uw液对供心有较好的保护作用；术后及时发现排斥反应与感染，并采取恰当的处理措施有利于受者顺利康复。Objective To summarize the preservation measures of the donor＇s heart and lung, and the postoperative imrnunotherapy, as well as the clinical experience of discrimination and management for graft rejection. Methods The clinical data of 2 cases of heart-lung transplantation in our department were retrospectively analyzed. Two different protective liquids were used for donor＇s lung lavage of 2 cases： Perfadx solution （1000 mL containing tris 0. 3 mL and ilomedin 25μg） ; Euro Collins solution （1000 mL containing tris 0. 3 mL and PGE1 100μg）. UW solution was used for donor＇s heart lavage. Surgical procedure for heart-lung transplantation was classic technique in situ. The schedule of immunosuppression was induced by Basiliximab, and combined with cyclosporine ＋ mycophemolate mofeil ＋ corcal hommone after operation, recipient＇s blood count, organ＇s functions, the sizes of every cavity of heart, IVSPW and LVPW were observed during early post-operation. The recipients were subjected to chest CT scan, fiberoptic bronchoscope and tissue pathological study when necessary to find the signs of rejection promptly. When the rejection occurred in the recipient, cortical hormones impulse therapy was given and the dose of immunosuppression was adjusted in time. Results Two patients discharged in 80 days and 141 days after operation. The patients were followed up for 54 months and 50 months respectively, and their life qualities were very well. Acute rejections occurred on the 10th and 26th day in one case, and in another case, acute rejections occurred on the 29th and 87th day after operatiorL All were conversed by cortical hormone＇s impulse therapy and adjusting the dose of immunosuppressants. When acute rejection occurred, the blood count had significant change, and IVSPW and LVPW were increases. They were returned the normal range after corresponding therapy. Conclusion Perfidx solution and Euro-Collin solution may play good protective roles for donor＇s lungs. UW solution may play good a protecti

关 键 词：心肺移植 器官保存 移植物排斥 诊断 治疗 

分 类 号：R655.3[医药卫生—外科学] R654.2[医药卫生—临床医学]