三例原位心脏移植的疗效分析

Analysis on the therapeutic effects of orthotopic heart transplantation in 3 cases

自1992年4月以来我们成功地实施了3例原位。心脏移植。术中供。心保护采用经冠状静脉窦连续灌注含钾微温血。2例采用原位心脏移植的标准术式，1例采用全心脏原位移植术。采用连续血管内股外翻缝合。术后患者恢复佳，无并发症，心功能Ⅰ级，已分别有活5年、3年和1年半。我们认为微温血持续逆灌可使供心提前得到氧和血的供应，改善供心保护效果。正确的手术方法、早期发现急性排斥反应和正确的处理等是提高移植后近、远期疗效的重要因素。

From April 1992, othotopic heart transplantation (OHT) was successfully performed in 3 patients with late stage cardiomyopathy' The donor hearts were preserved by continuous retrograde reperfusion of tepid blood containing potassium during implantation. Among 3 cases, 2 underwent standard OHT, one total OHT. Anastomoses were sutured in a continuous everting fashion. All patients were survived with good quality of life with survival time being 5 years, 3 years and 1 year, respectively. It was suggested that continuous tepid reperfusion during implantation of donor heart is technically fcasiblc and sccms to provide enhanced myocardial preservation.Correct surgical procedures, carly diagnosis and effective treatment of acute rejection were the important factors for the improvement of early and late therapeutic effects after transplantation.