同种异体原位心脏移植36例临床分析  

Clinical analysis of 36 patients with allograft orthotopic heart transplantation

作　　者：景启明 王睿[1] 陈鑫[1,2] JING Qiming;WANG Rui;CHEN Xin(Department of Thoracic and Cardiovascular Surgery,Nanjing First Hospital,Nanjing Medical University,Nanjing,210006,P.R.China;School of Medicine,Southeast University Medical College,Nanjing,210009,P.R.China)

机构地区：[1]南京医科大学附属南京医院南京市第一医院心胸外科,南京210006 [2]东南大学医学院,南京210009

出　　处：《中国胸心血管外科临床杂志》2019年第10期968-972,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的分析同种异体原位心脏移植患者的临床疗效。方法回顾性分析2014年1月1日至2019年1月1日于南京市第一医院心脏中心实施的36例同种异体原位心脏移植患者的临床资料,其中男31例、女5例,年龄23~65(46.2±8.8)岁。受体患者原发病包括扩张型心肌病33例,终末期冠心病2例及终末期瓣膜性心脏病1例。心脏移植手术术式均采用双腔静脉吻合法。术中免疫诱导均采用巴利昔单抗与甲强龙联合治疗。术后均采用新三联免疫抑制方案:FK506+骁悉+泼尼松。结果围手术期1例患者因严重感染死亡。心力衰竭8例,经调整及主动脉内球囊反搏(IABP)辅助治疗后心功能均好转。肾功能衰竭5例,经连续性肾脏替代治疗(CRRT)后,肾功能均恢复正常。术后随访3~49(16±4)个月,1例患者术后1年因移植物功能衰竭死亡,1年生存率为97.1%(34/35)。其中10例为边缘供体,与常规供体比较差异无统计学意义。结论对于终末期心脏病,心脏移植是有效的治疗手段之一,近中期疗效满意。合理应用IABP、CRRT等辅助治疗手段和新三联抗排异方案,可显著提高心脏移植手术成功率,减少急、慢性排斥反应的发生。边缘供体的应用,可以在一定程度上缓解目前供体短缺的现状。Objective To analyze the clinical effects of allograft orthotopic heart transplantation. Methods The clinical data of 36 patients with allograft orthotopic heart transplantation performed in the Heart Centre of Nanjing First Hospital from January 1, 2014 to January 1, 2019 were retrospectively analyzed. There were 31 males and 5 females, aged 23-65 (46.2±8.8) years. Protopathy diseases of recipients included dilated cardiomyopathy in 33 patients, end-stage coronary heart disease in 2 patients, and end-stage valvular heart disease in 1 patient. Heart transplantations were performed through double vena cava anastomosis. Immune induction during operations was treated with a combination therapy of both bariximab and methylprednisolone. Postoperatively, all patients were treated with a new triple immunosuppression protocol: FK506+cellcept+prednisone. Results During the perioperative period, 1 patient died of severe infection. For 8 patients with heart failure, after adjustment and intra-aortic balloon pump, the cardiac function of all the 8 patients improved. For 5 patients with renal failure, after continuous renal replacement therapy, the renal function of all the patients returned to normal. One patient died of graft failure after 1 year of follow-up. The follow-up time for each patient postoperatively differed from 3 to 49 months with an average time of 16±4 months while the 1-year survival rate was 97.1%(34/35). Among them, 10 patients were marginal donors, with no significant differences between conventional donors and them. Conclusion For end-stage heart diseases, heart transplantation is one of the effective treatment methods in China with fine early- and middle-term curative effects. Reasonable application of intra-aortic balloon pump, continuous renal replacem ent therapy and other adjuvant treatm ents and the new triple immunosuppression protocol can significantly improve the success rate of heart transplantation, reduce the occurrence of acute and chronic rejections. The application of marginal donors ca

关 键 词：同种异体原位心脏移植 终末期心脏病 免疫抑制治疗 

分 类 号：R654.2[医药卫生—外科学]