摘要
目的 总结 2例同种原位心脏移植的临床经验。方法 男性患者年龄分别为 4 0岁和 4 1岁 ,术前诊断 :1例为风湿性联合瓣膜病 ,另 1例为扩张型心肌病。术前心功能Ⅳ级 ,均为终末期心脏病。超声测定左室舒张末内径(LVEDD)分别为 96mm、1 0 1mm ,射血分数 (EF)为 2 6 %、2 7%,肺动脉压 4 2mmHg、30mmHg。心脏移植手术在全麻低温体外循环下进行 ,行双腔静脉原位心脏移植。供心热缺血时间分别为 3min、4min ,冷缺血时间 1 80min、1 2 5min ,主动脉阻断时间 95min、84min ,心脏均自动复跳。术后早期应用前列腺素E1 ,采用FK5 0 6、甲基强的松龙、骁悉三联抗排异药物治疗。应用心肌内心电图 (IMEG)、心肌活检监测免疫排斥反应。结果 2例患者全部存活 ,病人术后未发生急性排异反应。出院后随访 1～ 3个月心功能均为Ⅰ～Ⅱ级 ,恢复工作。结论 心脏移植是治疗终末期心脏病的有效方法 ;作为一种监测排斥反应的无创方法 ,IMEG可以明显减少心肌活检的次数。
Objectives To summarize the experience of 2 cases of cardiac orthotopic transplantation. Methods Two male patients aged 40 and 41 years, one was diagnosed as combined rheumatic valve disease and another was dilated cardiomyopathy. All the two patients were of NYHA Ⅳ and had end-stage heart failure. The ultrasound examination showed that LVEDD were 96 mm and 101 mm, EF were 26% and 27%, pulmonary artery pressure were 42 mmHg and 30 mmHg. Heart transplantations were performed with orthotopic bicaval technique under extracorporeal circulation. The hot ischemic time were 3 and 4 min and cold ischemic time were 180 and 125 min, the time of aortic clamp were 95 and 84 min. The hearts were self-recovery after aortic declamped. PGE 1 was early used during postoperative period, postoperative immunosuppressive therapy were applied with tacrolimus plus mycophendate mofeti and methyl-prednisolone. Intramyocardium Electrocardiography (IMEG) and Endomyocardium Biopsy (EMB) were used to monitor the rejection. Results The patients were well recovered and discharged without acute rejection. Conclusions Cardiac transplantation is an effective method to treat the end-stage heart failure. IMEG was an non-invasive method to monitor the rejective reaction and also can reduce the frequence of EMB.
出处
《岭南心血管病杂志》
2004年第5期313-315,共3页
South China Journal of Cardiovascular Diseases
关键词
同种原位心脏移植
排异反应
手术方法
心电图
心肌保护
Heart transplantation
End-stage heart disease
Rejective reaction
Intramyocardium electrocardiography
