摘要
目的探讨原位心脏移植长期存活的原因和价值。方法选自2004-10～2012-12在广西壮族自治区人民医院和解放军181医院进行同种异体心脏移植患者34例。男性29例,女性5例;年龄12～56岁。扩张型心肌病30例,肥厚型心肌病2例,冠心病2例。心脏功能Ⅲ～Ⅳ级。全部病例均采用双腔静脉吻合法进行原位移植。对患者的个体因素、供心保护、手术过程、围手术期情况、免疫抑制剂治疗和术后检测情况、生活质量进行分析。随访1～99个月。结果早期死亡3例,其中2例死于肺动脉高压危象-右心功能衰竭。出院的31例患者全部存活,心脏功能恢复Ⅰ～Ⅱ级。存活3年以上13例,其中8年以上1例,心功能Ⅰ级,已生育一小孩。免疫抑制剂血液浓度监测和B型超声检查未发现异常。64排CT检查未发现冠状动脉有狭窄表现。结论组织配型、供心保存、缺血-再灌注损伤、手术过程、免疫抑制剂合理使用是移植后长期存活的关键因素,防治免疫排斥、代谢、感染等是防治心脏移植物血管病变的重要措施。64排CT等非创伤性检查可作为常用的监测手段。
Objective To analyze the reasons and value of long-term survival of the patients after heart transplantation. Methods From Oct 2004 to Dec 2012, 34 patients（ 29 males, 5 females, age 12 ~ 56 years） un- derwent bicaval orthotopic cardiac transplantation in Guangxi Zhuang Autonomous Region People＇ s Hospital and 181 Hospital of P. L.A. These patients included 30 cases of dilated cardiomyopathy, 2 hypertrophic cardiomypathy and 2 coronary artery disease. Cardiac functions were grade m ~ IV. The analysed factors included individual factors, oper- ative procedures, perioperative period status,immunosuppressive therapy and detection, and life quality. The follow-up period were 1 ~ 99 months. Results Early death were 3 cases and 2 patients died of pulmonary hypertension crisis- fight -~entficular function failure. M1 31 discharged patients survived, their cardiac functions restored to grade I ~ lI, the follow-up period of 13 cases were over 3 years, follow-up period of 1 case was over 8 years（this patient had given birth to a child）. No abnormal reaction was observed by immunosuppressive concentration detection and B-ultrasonography examination. No stenosis of coronary artey was observed by 64-slice spiral CT. Conclusion The main factors long-term survival include HLA typing sera, ischemia reperfusion injury, and fair use of immunosuppressive medicine. Preventing immunologic rejection and infection are important measures to prevent heart transplant angiopathy. Noninvasive examinations such as 64-slice spiral CT could become common monitoring mearures.
出处
《中国临床新医学》
2013年第2期99-101,共3页
CHINESE JOURNAL OF NEW CLINICAL MEDICINE
基金
广西自然科学基金资助项目(编号:0235024-1)
关键词
心脏移植
供体心脏保存
心脏移植物血管病变
长期存活
Heart transplantation
Donor heart pretection
Heart transplant angiopatby
Long survival
