自体骨髓干细胞移植治疗急性心肌梗死围手术期并发症分析

Analysis of perioperative complication during treating acute myocardial infarction by autologous bone marrow stem cell transplantation

目的:分析自体骨髓干细胞经冠脉移植治疗急性心肌梗死患者围手术期并发症情况。方法:抽取2004-09/2006-12唐山工人医院收治的急性心肌梗死患者40例,均行经皮冠状动脉介入治疗+标准药物治疗+经冠脉注入自体骨髓单个核细胞治疗,实验方案经医院伦理委员会批准,并获得患者知情同意,术前及术后根据临床需要给予标准药物治疗。于患者双侧髂后上棘穿刺,抽取骨髓,滤筛去除脂肪颗粒及骨渣,共采集100～120mL,经密度梯度离心获得骨髓单个核细胞悬液12～15mL,室温下保存少于4h。两侧冠脉造影,左前降支植入支架后,将导丝放置于原病变远端,沿导丝将over the wire球囊置入支架内,将分离的骨髓单个核细胞悬液经over the wire球囊导管中心腔内注入梗死相关动脉血管远端,每次注射4.0～5.0mL,抽空球囊间歇2min后再次同法注射,反复共3次。结果:40例行骨髓单个核细胞冠脉移植的心肌梗死患者均进入结果分析。围手术期各种并发症共34例次,其中血管并发症发生率20%,胸痛17.5%,心律失常15%,低血压12.5%,心功能障碍10%,迷走神经反射7.5%,低血糖反应2.5%。结论:随着冠状动脉介入治疗技术的开展和操作的规范,手术成功率逐步提高,但仍然会在围手术期出现各种并发症及突发事件。提示应严密观察病情,有针对性地采取预防措施和正确的应急处置,从而减少干细胞移植手术的风险。

AIM： To analyze the perioperative complications for the treatment of acute myocardial infarction （AMI） by autologous bone marrow stem cell transplantation. METHODS： Forty AMI patients, who were treated by autologous bone marrow mononuclear cell transplantation, standard medication and percutaneous coronary intervention in Tangshan Worker＇s Hospital between September 2004 and December 2006, were selected in this study. All of the treatments were approved by the Hospital Ethics Committee and all of the patients knew the facts saying yes. All patients were treated by standard medication according to the clinical needs before and after operation. Bone marrow was drawn off by puncturing at two side of posterior superior iliac spine, and then fat particles and bone chippings were filtrated. The total amount of bone marrow collecting was 100-120 mL. Bone marrow mononuclear cell suspension of 12-15 mL was got by density gradient centrifugalization, which should be preserved within 4 hours at room temperature. After bilateral coronary artery angiograghy and frame transplantation into left anterior descending branch, guide wire was placed the distant end of sick area, and ＇over the wire＇ balloon was put into the frame along the guide wire. Then the bone marrow mononuclear cell suspension was injected into into the distant end of AMI-related vessels, which were infracted through the central cavity of the ＇over the wire＇ balloon. The amount of injection was 4.0-5.0 mL for each time. With the intermission of 2 minutes after the balloon was vacuated, the cell suspension was injected by the same method. This process was repeated 3 times. RESULTS： All of 40 AMI cases undergoing autologous bone marrow mononuclear cell transplantation were analyzed in the result. There were 34 various perioperative complications and the incidence was as follows： blood vessel complication 20%; chest ache 17.5%; arrhythmia 15%; hypotension 12.5%; cardiac insufficiency 10%; vagus reflex 7.5%; hypoglycemia 2.5%. CONCLUSION： Along with the development and the operative technique standardization of coronary artery intervention therapy, the successful rate of operation is gradually increasing. But there are still some complications and sudden events that occur in perioperative period, which suggest that observing the states of illness rigorously, adopting prevention measures and proper lash-up treatment pertinently can reduce the risk of stem cell transplantations.