同种异体原位心脏移植受者疗效分析  

Clinical efficacy of orthotopic heart transplantation for 40 patients

作　　者：王砚池 刘天起[1] 王东[1] 厉泉[1] 李培杰[1] 毕严斌[1] 李敏[1] 许莉[1] 马延平[1] 王明华[1] 

机构地区：[1]山东大学附属千佛山医院心脏外科,山东济南250014

出　　处：《山东大学学报（医学版）》2014年第12期60-63,68,共5页Journal of Shandong University:Health Sciences

摘　　要：目的探讨分析原位心脏移植术治疗终末期心脏病的疗效。方法回顾性分析同种异体原位心脏移植受者40例的临床资料。其中扩张型心肌病29例、缺血性心肌病6例、肥厚型心肌病4例和限制性心肌病1例。免疫抑制治疗采用环孢素+糖皮质激素+吗替麦考酚酯三联方案,35例受者给予抗Tac单克隆抗体或巴利昔单克隆抗体的诱导治疗。根据血药谷浓度(C0)与峰浓度(C2)调整环孢素的使用。结果术后1个月存活率95%(38/40)。1、3、5年生存率分别为90%、82.5%、77.5%。受体主要死亡原因包括右心衰竭、真菌感染及移植物衰竭。出现急性排斥反应7例,经激素冲击治疗后均逆转,排斥反应发生率17.5%。采用环孢素血药浓度C0、C2同时监测后发生排斥反应3例,发生率15%。结论心脏移植术治疗各种终末期心脏病疗效确实可靠,C0、C2同时监测可控制环孢素浓度在有效的范围内,避免早期急性排斥反应的发生。Objective To summarize and analyze the clinical efficacy and experiences of orthotopic cardiac transplanta- tion for end-stage heart disease. Methods Data of 40 patients underdoing orthotopic heart transplantation in our center in the past 10 years were retrospectively reviewed. The enrollments included 29 cases of dilated cardiomyopathy, 6 ca- ses of ischemic heart disease, 4 cases of hypertrophic cardiomyopathy, and 1 case of restrictive cardiomyopathy. Immu- nosuppressive therapy with cyclospofine A, corticosteroid, and mycophenolate mofetile was adopted. Thirty-five pa- tients received induction therapy with Tac monoclonal antibody or basiliximab monoclonal antibody. According to trough concentration （C0） and peak concentration （ C2）, the dose of cyclosporine A was regulated. Results The rate of successful operation was 95% （38/40）. The 1-, 3-, 5- year survival rate was 90%, 82.5%, and 77.5%. Main causes of death were fight heart failure, fungal infection, and graft failure. Acute rejection occurred in 7 cases （ 17.5% ）, and all recovered after cortieastefiod impulse therapy. Three cases were diagnosed as rejection after CO and C2 were monitored spontaneously. Conelusion It＇s reliable to treat patients with end-stage heart disease with orthotopic cardiac transplantation. Monitoring CO and C2 can control the cyclospofine concentration within the valid range and avoid occurrence of early acute rejection.

关 键 词：心脏移植 终末期心脏病 免疫抑制治疗 环孢素浓度 感染 

分 类 号：R654.2[医药卫生—外科学]