心肺联合移植的临床研究(附1例报告)

The clinical study of heart-lung transplantation (report of 1 case)

目的介绍成功开展心肺联合移植的经验。方法2006-03-23对1例先天性心脏病室间隔缺损合并重度肺动脉高压、艾森门格综合征的患者,施行心肺联合移植术。受体采用心脏及两肺分别切除法,在隆突上作气管吻合,心脏作双腔静脉法吻合。结果患者术后恢复顺利,1.5h神志清醒,22h拔除气管插管,第4日下床活动,术后未发生急性排斥反应,于术后第9周发生溶血葡萄球菌肺炎,经抗感染治愈,109d痊愈出院,至今生存7个月,可参加一般体育活动。结论重视供受体人类白细胞抗原(humanleucocyteantigen,HLA)配型、有效的心肺保护技术、细致的手术操作技术、合理有效的抗排斥及抗感染方案是心肺移植成功的关键。

Objectives To summarize the experiences of heart-lung transplantation.Methods One patient,diagnosed as ventricular septal defect and Eisenmenger syndrome,underwent heart-lung transplantation in 23 May 2006.The techniques of sequential removal of the heart and lungs,the tracheal anastomosis above the carina and bicaval heart transplantation were used.Results The operation was successful.The patient was awaken after 1.5 hours,extubated after 22 hours,then began ambulation for 4 days,and no acute rejection was found.Pulmonary staphylococci infection at 9 weeks postoperatively had treated,discharged 109 days later,the survival until now was 7 months.Conclusions The successful operation of heart-lung transplantation depends on good HLA matching,better myocardial and lung protection,suitable operative procedures,effective monitoring and treatment of rejection and infection.