摘要
目的对30例心脏移植进行分析总结。方法30例患者中,24例的原发病为扩张型心肌病,4例为终末期瓣膜性心肌病,1例为终末期缺血性心肌病,1例为病毒性心肌炎行双心室辅助术后1个月。均在体外循环下行原位心脏移植术,3例采用标准心脏移植术式,27例采用双腔静脉吻合心脏移植术式,体外循环时间(75±24)min,主动脉阻断时间(72±8)min。术后采用环孢素A、霉酚酸酯和泼尼松预防排斥反应,根据血环孢素A的浓度调整CsA的用量。术后早期,每天行心肌内心电图及超声心动多普勒监测,以便早期发现急性排斥反应,必要时行心内膜心肌活检。结果30例患者中,术后死亡5例,3例死于低心排,1例死于感染所致的多器官功能衰竭,1例死于出血。术后并发症有低心排、心律失常、三尖瓣返流、右心衰竭、细菌和真菌感染、肾功能异常及血糖升高,上述并发症除导致死亡者外,其余经治疗好转;4例发生急性排斥反应,给予甲泼尼龙冲击治疗,并调整免疫抑制剂的用量后排斥反应逆转。结论术后并发症的预防和及时正确的处理,是心脏移植成功的关键,尤其是对感染、急性排斥反应、右心功能不全及肾功能异常的预防和处理。
Objective To sum up the experience of perioperative management of patients with heart transplantation. Methods In recent 3 years 24 cases of dilated cardiomyopathy, 4 cases of serious valve disease, 1 case of serious ischemic cardiomyopathy and 1 case of bi-ventricular assist received heart transplantation surgery. The mean by pass time was 75 ± 24 rain and the mean aortic clamp time was 72 ± 8 min. Cyclosporine, MMF and prenisodone were adopted as anti-immune response strategy and the dose of cyclosporine was adjusted according to the serum concentration. Intramyocardial electrograms and tissue Doppler ultrasound technique were used to monitor the immune response situation. The myocardial biopsy was performed in case of the suspect of acute rejection. Results In 5 postoperative deaths, 3 cases died of low cardiac output, 1 died of infectioninduced multiple organ failure and 1 case died of serious bleeding. The postoperative complications included right heart failure in 6 cases, renal failure in 73 cases, and acute rejection in 4 cases. Conclusion The effective prevention and management of complications is the key point of success of heart transplantation. Application of comprehensive monitoring techniques is beneficial to the management of the immune rejection after transplantation.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2006年第7期424-427,共4页
Chinese Journal of Organ Transplantation
关键词
心脏移植
手术期间
治疗结果
Heart transplantation
Intraoperative period
Treatment outcome
