心肌内心电图在监测心脏移植术后急性排异反应中的应用

Intramyocardial Electrocardiogram in Diagnosis of Acute Rejection after Heart Transplantation

目的:探讨心肌内心电图(intramyocardial electrogram,IMEG)监测心脏移植术后急性排异反应的可行性。材料与方法:选取2004年4月～11月间于山东大学齐鲁医院行同种异体原位心脏移植的2例患者,将采用IMEG诊断的急性排异反应结果与采用临床症状、体表心电图、心脏彩色多普勒、胸片和心肌酶谱联合诊断结果进行对照,以判断IMEG在监测心脏移植术后急性排异反应中的作用。结果:2例患者分别于心脏移植术后第8天和第9天出现IMEGQRS波振幅下降,下降幅度与术后即刻比较分别为27%和30%,提示急性排异反应发生。经治疗后IMEGQRS波振幅恢复正常,与联合诊断结果有很好的相关性。结论:采用IMEG监测急性排异反应,敏感,可靠,无创伤,可作为心脏移植患者抗排异疗效观察及选择性心内膜活检的依据。

Objective： To evaluate the reliability of intramyocardial electrocardiogram（IMEG） monitoring during episodes of acute rejection after heart transplantation, 2 cases of homogeneous orthotopic heart transplant recipients were reviewed. Materials and Methods： From April to November in 2004, 2 homogeneous orthotopic heart transplants were performed in Qilu hospital of Shandong University. Acute rejection after transplantation was monitored by IMEG as well as clinical features, body surface electrocardiogram, echocardiography, thoracic radiograph and myocardial enzymogram. Results： The voltage amplitude of IMEG QRS complex decreased 27% on the 8th day after heart transplantation in one recipient and 30% on the 9th day in another, which is highly indicative of acute rejection that was verified by combinative diagnosis of clinical features, body surface electrocardiogram, echocardiography, thoracic radiograph and myocardial enzymogram. Conclusions： IMEG is a sensitive, reliable and non-invasive method monitoring acute rejection after heart transplantation, which is specially suitable for monitoring rejection therapy and helpful in making decision to have recourse to endomyocardial hiopsies,