摘要
目的 观察经皮经腔冠状动脉内移植自体外周血干细胞 (PBSC)治疗急性心肌梗死 (AMI)的可行性与安全性。方法 患者入院后在常规急性心肌梗死治疗 (药物与介入治疗 )基础上给予包涵体型G CSF(商品名惠尔血 ) 30 0～ 6 0 0 μg/d皮下注射 ,连续 5d ;或分泌型G CSF(商品名金磊赛强 ) ,6 0 0 μg/d皮下注射 ,连用 5d。第 6d经美国Baxter公司生产的CS30 0 0PLUS血细胞分离机 ,分离外周血干细胞悬液 5 0mL ,采集后干细胞未做任何处理 ,常规经皮经腔导管技术建立梗死相关动脉 (IRA)通道 ,利用over the Wire球囊封闭IRA ,并将分离的PBSC经Over the Wire导管中心腔注入IRA。在外周血干细胞动员时观察有无骨痛 ,乏力 ,皮疹 ,发热 ,胃肠道反应 (恶心、呕吐、便秘 ) ,心绞痛或心衰加重及一些少见的并发症 :自发性脾破裂、严重化脓性感染、高凝状态、自身免疫性疾病等发生 ;在外周血干细胞分离及采集过程中观察有无低钙性口周麻木、抽搐 ,迷走神经反应性面色苍白、晕厥 ,低血容量性面色苍白、晕厥 ,心绞痛发作 ,心衰加重等 ;在自体外周血干细胞经冠状动脉内回输过程中可出现心律失常 ,如 :窦性心动过缓 (球囊封堵所致 )、窦性停搏 (窦停 )或三度房室传导阻滞 (AVB) (球囊刺激支架近端引起严重的冠脉痉挛所致 )。
Objective To observe the safety and feasibility of autologous peripheral blood stem cell (PBSC) transplantation by intracoronory infusion in patients with acute myocardial infarction (AMI).Methods Totally 27 patients with AMI were randomly allocated to receive either inclusive type granulocyte colony-stimulating factor (G-CSF),or excretory type G-CSF to mobilize the stem cells.They received the dose of G-CSF 300-600μg/d by hypodermic injection for 5 days.On the sixth day,PBSCs were separated by Baxter CS 3000 blood cell separator into 50ml suspending liquid.The suspending liquid without treatment was infused into the infarct-related artery (IRA)by occluding the over-the-wire balloon and infusing artery through balloon center lumen.During PBSC mobilization,the following side-effects should be paid attention to,such as bone pain,lethargy,tetter,fever,gastrointestinal effects (nausea,vomiting,constipation),angina or deteriorated heart failure,as well as some rare complications (spontaneous spleen rupture,severe purulent infection, hypercoagulable state,and autoimmune diseases).When the PBSCs were being separated and collected,some complications were observed,for example,low calcium effects (mouth numbness and spasm),pale and dizziness due to vagus reflect,pale and dizziness owing to low blood volume,deterioration of angina or heart failure.The complications should also be observed during the PBSC transplantation by intracoronary infusion:arrhythmia including bradycardia (because of balloon occlusion),sinus arrest or the third degree of atrial ventricular block (because of coronary spasm due to balloon stimulating stent), ventricular fibrillation or hypotension,etc.Results There were 22 cases with complications during the mobilization,separation,collection, and infusion of PBSCs.The incidence of complications during mobilization was 44.4%(12/27),during separation and collection is 25.9%(7/27),and during PBSC transplantation by intracoronary infusion 11.1%(3/27).Conclusion In patients with AMI,Intracoronary infusion of PBSC is feasible and safe.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2004年第5期274-276,共3页
Chinese Journal of Practical Internal Medicine
关键词
自体外周血干细胞
移植治疗
急性心肌梗死
安全性
疗效观察
Acute myocardial infarction Peripheral blood stem cell Cardiac function Transplantation Granulocyte colony-stimulating factor (G-CSF)
