肾脏移植术后免疫抑制治疗下施行心脏手术的疗效分析

Cardiac Surgery after Kidney Transplantation Underwent Immunosuppression Therapy

目的分析肾脏移植术后免疫抑制治疗下施行心脏手术的临床效果。方法回顾性分析2011年1月至2013年10月北京安贞医院心脏外科施行心脏手术的6例肾脏移植术后免疫抑制治疗患者的临床资料,其中男4例、女2例,年龄27-66岁。所有患者均有肾脏移植术史,距离手术时间为6-10年,平均（8.5±1.7）年。3例行主动脉瓣置换术,1例行二尖瓣置换术,2例行非体外循环下冠状动脉旁路移植术。结果 6例患者术后均痊愈出院,无死亡病例及并发症。手术时间（237.0±93.0）min,体外循环时间（101.3±16.7）min,主动脉阻断时间（75.6±9.7）min,住院时间（17±6）d。全组术前、术后左心室射血分数差异有统计学意义（63.5%±4.5%vs.56.5%±5.8%,P〈0.05）;术前、术后左心室舒张期末内径差异有统计学意义[（54.5±8.5）mm vs.（43.7±6.8）mm,P〈0.05];术前、术后肌酐差异无统计学意义[（103.7±15.1）μmol/L vs.（106.6±34.7）μmol/L,P〉0.05]。电话和门诊复查方式随访6例,随访率100%。随访时间4-15个月,治疗效果良好,心功能均达Ⅰ-Ⅱ级,生活质量较术前明显提高。结论只要采用正确的方法进行手术和围术期管理,肾脏移植术后免疫抑制治疗下施行心脏手术安全可行。

Objective To analyze the clinical outcomes of cardiac surgery in patients after kidney transplantation underwent immunosuppression therapy. Methods Clinical data of 6 patients（including 4 males and 2 females aged from 27 to 66 years） undergoing cardiac surgery after kidney transplantation with immunosuppression between January 2011 and October 2013 in Beijing Anzhen Hospital were retrospectively analyzed. Two patients underwent off pump coronary artery bypass grafting, 3 patients underwent aortic valve replacement and 1 patient underwent mitral valve replacement. The interval between kidney transplantation and cardiac operation was 8.5±1.7 years（range, 6-10 years）. Results All the operations were performed successfully without in-hospital death and complications. Operation time was 237.0±93.0 min. Cardiopulmonary bypass（CPB） time was 101.3±16.7 min. Aortic cross-clamping time was 75.6±9.7 min. In-hospital stay was 17±6 d. There was a statistical difference in preoperative and postoperative left ventricle ejection fraction（63.5%±4.5% vs. 56.5%±5.8%, P〈0.05）, as well as preoperative and postoperative left ventricular enddiastolic diameter（54.5±8.5 mm vs. 43.7±6.8 mm, P〈0.05）, but there was no statistical difference in preoperative and postoperative serum creatinine levels（103.7±15.1 μmol/L vs. 106.6±34.7 μmol/L, P〉0.05）. The mean follow-up time of the6 patients was 4-15 months. The follow-up rate was 100%. All the patients were in cardiac function NYHA class Ⅰ- Ⅱ. And the quality of life was improved. Conclusion Cardiac operations for kidney transplant recipients undergoing immunosuppressive treatment are effective and safe as long as appropriate perioperative treatment are taken.