29例原位心脏移植近期疗效报告  

A report of 29 cases with early outcome of orthotopic heart transplantation

作　　者：潘禹辰[1] 罗爱国[1] 朱中权[1] 唐开维[1] 轩永波[1] 左艳[1] 展宇飞 

机构地区：[1]中国人民解放军第181医院心脏中心,广西541002

出　　处：《心肺血管病杂志》2014年第1期28-30,37,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的：总结29例原位心脏移植的近期疗效.方法：2006年10月至2012年12月,对29例终末期心脏病患者行原位心脏移植治疗.受体肺血管阻力为3.6～5.2 wood单位,平均（4.2±1.8）wood单位;应用4℃的HTK液保护供心,供心冷缺血时间为63～360 min,平均（95.5 ±26.7）min;29例均采用双腔静脉吻合法原位心脏移植手术;术前使用免疫诱导治疗,术后采用环孢素A、霉酚酸酯和泼尼松预防急性排斥反应.结果：术后死亡2例,1例死于术后低心排出量综合征（低心排）,1例死于急性右心衰竭.术后早期并发症有急性右心衰竭3例,急性肾衰竭2例,心包大量积液4例.结论：心脏移植近期疗效满意.选择肺血管阻力较低的患者、妥善的供心心肌保护、熟练的手术操作、合理应用免疫抑制剂和正确处理术后肾功能不全是提高心脏移植近期疗效的重要措施.Objective：To report the preliminary experience of 29 orthotopic heart transplantations.Methods：Between October 2006 and December 2012,29 patients underwent orthotopic heart transplantation.Recipients pulmonary vascular resistance ranged from 3.6 ～ 5.2 woodunits,mean （4.2 ± 1.8） wood units ;4℃ HTK solution was perfused for donor heart myocardial preservation,donor heart cold ischemic period ranged from 63 ～360min,mean （95.5 ± 26.7）min ;The operative procedure was bicaval anastomotic cardiac transplantation in 29 cases;Recipients received simulect preoperatively and cyclosporine A,cellcept and prednisone postoperatively for prevention of acute allograft rejection.Results：In 2 postoperative deaths,1 case died of low cardiac output and 1 died of acute right heart failure.The early postoperative complications included acute right heart failure in 3 cases,acute renal failure 2 cases and pericardial effusion in 4 cases.Conclusion：Heart transplantation may produce satisfying early results.Suitable selection of recipients with low pulmonary vascular resistance,excellent donor heart conservation,practised anastomotic technique,proper immuro suppression treatment and efficient postoperative management are key measures of orthotopic heart transplantation with excellent early outcome.

关 键 词：心脏移植 终末期心脏病 治疗结果 

分 类 号：R54[医药卫生—心血管疾病]