原位心脏移植治疗终末期心肌病七例

Seven Cases of Orthotopic Cardiac Transplantation for End-stage Heart Disease Treatment

目的:探讨心脏移植围手术期治疗的方法及疗效。方法:对7例终末期心肌病患者施行同种异体原位心脏移植术。前3例行标准Stanford原位心脏移植术,后4例行双腔静脉法原位心脏移植术。前2例采用达利珠单抗+霉酚酸酯诱导方案,后5例采用巴利昔单抗+霉酚酸酯诱导方案。术后均使用普乐可复(FK506)+骁悉(MMF)+泼尼松(Pred)三联免疫抑制剂。结果:1例术后出现血糖升高,给予胰岛素治疗后血糖恢复正常。3例术后早期出现急性肾功能衰竭,2例分别给予持续肾脏替代治疗(CRRT)后肾功能恢复正常,1例后因多器官功能衰竭死亡。6例存活患者均恢复正常工作和生活。结论:心脏移植是治疗终末期心肌病变有效的手段,完善的术前治疗、准确的手术时机把握、个体化的免疫抑制治疗应用、有效的血流动力学控制和及时的并发症处理可提高同种异体原位心脏移植术的疗效。

Objective： To summarize the clinical experience of seven cases of cardiac transplantation and discuss the perioperative management of the recipients. Methods： Seven patients with end-stage cardiomyopathy were treated by orthotopic heart transplantation. The Stanford orthotopic cardiac transplantation procedures were performed in the first three eases. The bieaval orthotopie cardiac transplantation procedures were performed in the other four eases. Two of the four cases were adopted ＂daclizumab ＋ mycophenolate mofetil＂ as immunosuppressive induction. Other five cases were adopted ＂basiliximab ＋ mycophenolate mofetil＂ as immunosuppressive induction. The postoperative immunosuppressive therapy consisted of FK506, MMF and prednison. Results： Hyperglycemia was happened in one patient and treated with insulin. Acute renal failure was found in three patients at the early stage after operation. Two of them were cured with continuous renal replacement therapy （CRRT）, the other one died of multiple organ failure. All of the six survivors resumed normal life and work. Conclusion： The cardiac transplantation is an effective therapy for end-stage cardiomyopathy. The result of heart transplantation can be improved by satisfactory pre-operative therapy,adequacy operative opportunity selection, individualized immunosuppressive therapy,proper control of hemedynamics and accurate management of pest-operative complications.