心脏移植及术后随访

Heart transplantation and follow-up.

目的总结3例心脏移植的初步经验。方法3例扩张性心肌患者进行了双腔静脉法的同种原位心脏移植，围手术期间给予受体的维护、供心离体时间长的保护、血流动力学的支持、抗排异反应及感染方面的处理。结果3例患者均存活，心功能由Ⅳ级提高到Ⅰ、Ⅱ级，分别随访19、28、49个月，2例因未正常服药发生排并反应。结论选择合适的供体和受体、良好的供心保护技术、有效的血流动力学支持、抗排异反应方案得当、防止感染是围手术期处理的重要组成部分，是手术成功的关键。正规服用抗排异药物是避免或减少排异反应的基本条件。

Objective To share the experience of heart thransplantation. Methods 3 recipients with terminal myocardiosis were reviewed. The transplantation was performed with inferior and superior vena anastomotie technique. During perioperative period, we selected and maintained the recipients, protected donor-isolated heart, supported circulation, decreased immune reaction and controlled infections. Results All the 3 patients survived . Heart function improved from NYHA class Ⅳ before heart transplant to NYHA class Ⅰ , Ⅱ. The follow-up time was 19 months ,28 months and 49 months respectively. Rejection occurred in two cases due to non-compliance to medication. Conclusions Suitable recipient, proper donor heart procurement and preservation, suitable maintenance of circulation, proper managements of anti-immunitive reaction, prevention of infections are critical for successful heart transplantation. Medicine-take required may avoid or reduce rejection.