复方磺胺甲噁唑联合早期停用皮质类固醇激素预防心脏移植术后感染并发症

Compound sulfamethoxazole combined with early discontinuation of corticosteroids hormones to prevent infection complication after heart transplantation

目的探讨复方磺胺甲噁唑和皮质类固醇激素对心脏移植术后感染并发症的影响。方法选取本院2011年1月至2013年3月实施同种异体原位心脏移植62例患者为研究对象,62例患者中6例失访,其余56例患者分为空白对照组（23例）、参考对照组（14例）和干预组（19例）。三组患者均采取相同的免疫抑制方案（他克莫司＋霉酚酸酯＋皮质类固醇激素）。空白对照组患者保持免疫抑制方案不变,不进行其他干预;参考对照组患者术后3个月内停用皮质类固醇激素;干预组患者术后3个月内停用皮质类固醇激素,同时口服复方磺胺甲噁唑。术后均随访6-24个月,评估三组患者心脏移植术后生存率、移植心脏排斥反应发生率以及感染、高血脂、高血糖等并发症发生率。结果干预组患者感染发生率显著低于参考对照组和空白对照组（P〈0.05）,参考对照组患者感染发生率显著低于空白对照组（P〈0.05）。干预组和参考对照组患者高血糖、高血脂发生率均显著低于空白对照组（P〈0.05）。三组患者移植术后生存率和排斥反应发生率比较差异均无显著性（P〉0.05）。结论心脏移植术后早期停用皮质类固醇激素并不会显著增加排斥反应的发生,但能明显减少感染、高血糖等并发症的发生,联合使用复方磺胺甲噁唑能有效预防心脏移植术后感染并发症的发生,是一种安全有效且经济实惠的预防手段。

Objective To explore influences of compound sulfamethoxazole and corticosteroid on complications after heart transplantation. Method 62 patients underwent orthotopic allograft heart transplantation implemented in our hospital from January 2011 to March 2013 were selected as objects of study. 6 patients out of 62 patients lost follow up, remained 56 patients were divided into blank control group（23 patients）, reference control group（14 patients） and intervention group（19 patients）. Three groups of patients adopted the same immunosuppression solution（tacrolimus ＋ mycophenolate mofetil ＋ corticosteroid hormone）. Patients in blank control group were treated with immunosuppression plan unchanged without other interventions. Patients in reference control group discontinued taking corticosteroids within 3 months after operations. Patients in ntervention group discontinued taking corticosteroids within 3 months after operations and orally took compound sulfamethoxazole. 6 - 24 months of postoperative follow-up were made after operation, the heart transplantation survival rate, incidence of rejection reaction, and incidences of complications including infection, hyperlipemia and hyperglycemia of patients were compared between the three groups. Result The incidence of infections in intervention group was significantly lower than blank control group and reference control group（P 0.05）, the incidence of infections in reference control group was significantly lower than blank control group（P 0.05）. The incidence of hyperglycemia, hyperlipemia in intervention group and reference control group were significantly lower than blank control group（P 0.05）. The comparison differences in survival rates and incidences of rejection reaction between the three groups were not significant（P 0.05）. Conclusion Early discontinuation corticosteroids after heart transplantation will not significantly increase the incidence of rejection reaction, but it can obviously reduce the incidence of complications including the infection, rejection reaction, and combined with compound sulfamethoxazole can effectively prevent the incidence of infection after heart transplantation, being a safe, effective and economical means of prevention.