扩心病合并多囊肾行心肾联合移植一例  

Combined heart and kidney transplantation： one case report

作　　者：柴军武[1] 王凯[1] 孔祥荣[1] 莫春柏[1] 周巍[1] 陈洪磊[1] 薛奋龙 Chai Junwu;Wang Kai;Kong Xiangrong;Mo Chunbo;Zhou Wei;Chen Honglei;Xue Fenlong.(Department of Cardiac Surgery, Tianjin First Central Hospital, Tianjin 300192, China)

机构地区：[1]天津市第一中心医院移植中心心血管外科,300192

出　　处：《中华器官移植杂志》2018年第3期145-148,共4页Chinese Journal of Organ Transplantation

基　　金：国家国际科技合作专项项目（2015DFG31850）

摘　　要：目的分析总结扩心病合并多囊肾患者接受心肾联合移植的治疗经验。方法回顾性分析1例心肾联合移植的临床资料，总结手术及术后治疗要点。供心与供肾来自于同一脑死亡供者，术中序贯完成心脏移植、。肾移植术，术中应用巴利昔单抗诱导和皮质激素冲击治疗，术后联合应用他克莫司、吗替麦考酚酯及皮质激素抗排斥反应治疗。结果心脏移植术中供心冷缺血时间为200min，主动脉阻断时间为136min，体外循环时间为201min，常规关胸后，稳定血压在130／80mmHg（1turnHg=0．133kPa）左右，同时经右侧髂窝行肾移植术，移植肾动脉开放后泌尿满意。术后15h拔除气管插管，术后第8天转入普通病房，术后27刚顷利出院，出院时心。肾功能均正常，无活动受限。结论精细的术前供者筛选、受者评估、手术方式选择、术后心肾功能管理及免疫抑制剂的应用是心肾联合移植手术成功的关键。Objective To summarize the outcomes and clinical experience of combined heart and kidney transplantation. Methods The clinical data of one case of combined heart and kidney transplantation were retrospectively analyzed. The kidney transplant was completed immediately after the heart transplant. The immunosuppressive therapy strategies included tacrolimus, corticosteroids and mycophenolate mofetil. Results For heart transplantation, heart cold ischemia time was 200 min, aorta blocking time was 136 rain, and extracorporeal circulation time was 201 rain. The kidney was transplanted to the right iliac fossa after heart transplantation. The endotracheal tube was removed 15 h after surgery. The patient was transferred to the general ward on the 8th day after surgery. The patient was discharged from the hospital at 27th day after surgery, the renal function was normal and no activity was restricted. Conclusion Reasonable perioperative management and selection of surgical methods are the keys to the success of combined heart and kidney transplantation.

关 键 词：尿毒症 心脏移植 肾移植 

分 类 号：R654.2[医药卫生—外科学]