摘要
目的总结5例同种异体原位心脏移植的治疗经验,探讨手术方式及术后围术期处理。方法2005年1月至2005年6月连续为5例终末期心脏病患者实施了原位心脏移植手术。术后免疫抑制剂应用环饱素A+骁悉+泼尼松"三联疗法。结合临床表现、超声心动图、化验检查及心肌内心电图,对心脏移植术后急性排斥反应的监测进行分析。结果5例手术均顺利,其中1例存活时间仅为9 d,其余均近期存活,生活质量良好。结论原位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,心肌内心电图可以明显减少心肌活检的次数。低血管阻力受体的选择和合理的免疫抑制治疗方案的应用是心脏移植成功的关键。
Objective To sum up the clinic experience of orthotopic cardiac transplantation in five eaese, and to investigate some important questions about selection of operative procedures and perioperative management. Methods From January 2005 to june 2005, Orthotopic cardiac transplantation was preformed on five patients with end-stage cardiomyopathy. Postoperative immunosuppressive therapy was applied with myclosporin A plus mycophenolate mofeti and predisone, and acute rejection was monitored by intramyocardium electrocardiography （IMEC） as well as by clinical feacture, ultrasonocardiograpyh and blood serum determination of tropin I, C-reactive protein （CRP） and lymphocyte. And by the combination of these methods, The data monitoring in acute rejection after the heart transplantation were analyzed Results The operations for 5 cases were all successful. Only one of the 5 cases survived for 9 days. The remaining got prolonged survival with good quality of life and without acute rejection. Conclusion Orthotopic cardiac transplantation is an effective method to treat the end-stage heart failure. IMEC is an non-invasive method to mormitor the rejective reaction and also can reduce the frequence of endomyocardial biopsy. Appropriate selection of recipients with low pulmonary vascular resistance and proper immurosuppression treatment are key measures of successful heart transplantation.
出处
《中国心血管杂志》
2006年第4期248-251,共4页
Chinese Journal of Cardiovascular Medicine
关键词
心脏移植
终末期心脏病
免疫抑制
心肌内心电图
监测
Heart transplantation
End-stage heart disease
Immurosuppression
Intrarnyocardiurn-electrocardiography
Monitoring
