110例原位心脏移植临床经验  

Clinical experience of 110 cases of orthotopic heart transplantation

作　　者：邹俊逸 张辉[2] 张歆杰 李子佳 许明雷 王东[2] ZOU Junyi;ZHANG Hui;ZHANG Xinjie;LI Zijia;XU Minglei;WANG Dong(Clinical Medical College,Weifang Medical University,Weifang 261053,Shandong,China;Department of Cardiology Surgery,Shandong Provincial Heart Transplantation Center,The First Affiliated Hospital of Shandong First Medical University,Shandong Provincial Qianfoshan Hospital,Jinan 250014,Shandong,China;Shengli Oilfield Central Hospital Affiliated to Binzhou Medical University,Dongying 257000,Shandong,China)

机构地区：[1]潍坊医学院临床医学院,山东潍坊261053 [2]山东第一医科大学第一附属医院,山东省千佛山医院心脏外科山东省心脏移植中心,山东济南250014 [3]滨州医学院附属胜利油田中心医院,山东东营257000

出　　处：《山东大学学报（医学版）》2021年第8期86-91,共6页Journal of Shandong University:Health Sciences

基　　金：山东省自然科学基金(ZR2011HL013);山东省科技发展计划(2014GSF118090)。

摘　　要：目的总结110例原位心脏移植治疗终末期心脏病患者临床经验及治疗效果。方法回顾性分析山东省千佛山医院心脏外科(山东省心脏移植中心)2003年3月至2020年7月完成的110例原位心脏移植供者及受者资料,从围手术期处理、免疫抑制的维持、感染监测、术后并发症的治疗以及随访指导等方面进行总结。结果手术成功率94.5%,术后并发症主要有右心功能不全(8.18%)、器官功能衰竭(15.76%)、急性排异反应(10.91%)、肺部感染(42.31%)及糖尿病(8.18%),均采用不同治疗方法取得满意效果。术后中位随访时间37个月(1~208个月),1、3、5年生存率分别为95.5%、84.2%、70.3%,其中9例存活超过10年。结论心脏移植是治疗终末期心脏病的最有效方法。手术治疗是成功的关键,通过采取术前评估供、受体质量匹配以及肝肾功能,术后给予个体化抗排异治疗,及时监测抗排异药物浓度,尤其是围手术期采用药物治疗、呼吸机支持、机械循环辅助装置以及持续肾脏替代和血浆置换等的综合治疗方法,可取得满意的近期和远期临床效果。Objective To summarize the clinical experience of orthotopic heart transplantation in 110 cases. Methods Clinical data of 110 cases of heart transplantation in Shandong Provincial Heart Transplantation Center during the past 17 years were retrospectively reviewed. The perioperative management, maintenance of immunosuppression, infection monitoring, management of postoperative complications and follow-up guidance were summarized. Results The success rate of operation was 94.5%. The main postoperative complications were right heart insufficiency(8.18%), organ failure(15.76%), acute rejection(10.91%), lung infection(42.31%) and diabetes(8.18%). Different treatment methods were used and satisfactory results were achieved. During the median postoperative follow-up of 37(1-208) months, the 1-year, 3-year and 5-year survival rates were 95.5%, 84.2% and 70.3%, respectively, and 9 cases survived for more than 10 years. Conclusion Heart transplantation is the most effective treatment for end-stage heart diseases. The key is the success of surgery. Before surgery, we evaluated donor and recipient conditions, matched recipient quality, and tested liver and kidney functions. After surgery, we timely individualized anti-rejection treatment and monitored drug concentration, especially used drug therapy, ventilator, mechanical circulation, continuous renal replacement and plasma exchange, and achieved satisfactory short-term and long-term results.

关 键 词：心脏移植 术后并发症 免疫抑制治疗 体外膜肺氧合 主动脉内球囊反搏 

分 类 号：R654[医药卫生—外科学]