同种异体原位心脏移植39例

ORTHOTOPIC HOMOLOGOUS HEART TRANSPLANTATION IN SITUS: A REPORT OF 39 CASES

目的 总结39例同种异体原位心脏移植体会以及远期随访结果。方法 回顾性分析自1995年8月-2003年2月共39例心脏移植病例,对其治疗经验和随访结果进行分析、总结。结果 本组39例受体术后早期(1周内)死亡7例,病死率17.9％,手术成功率82.1％,7例死亡病例中有5例死于术后急性右心功能衰竭,1例死于败血症,1例死于急性肾功能衰竭。晚期死亡病例5例,占存活总数的15.6％,远期存活率84.4％,其中1例死于心律失常,1例死于败血症,1例因并发肺部曲霉茵感染用二性霉素治疗后死于肝功能衰竭。对远期存活病例进行随访,所有病例的生活质量良好,心功能恢复至Ⅰ～Ⅱ级(NYHA)。结论 心脏移植是治疗终末期心脏病的有效方法,在手术早期为了提高手术的成功率,要重视围手术期对受体适应证的选择、选择合理的免疫抑制治疗方案以及对肾功能损害的处理尤其是对急性肾功能衰竭的处理。在远期的随访中,要根据具体情况合理调整环孢素的血药浓度以及重视对各种并发症的处理。

Objective To review the experience of the perioperative management and the long - term following in heart transplantaton. Methods 39 records were studied retrospectively for analysis of the experience. Results 7 cases died of the complications in perioperation and the mortality was 18.9% . 5 of 7 cases died of the acute right heart failure, one case died of the septicemia, the other case died of theacute renal failure. In the long - term following, 5 cases died of the complications and the long -term mortality was 15.6 % , 2 of 5 cases died of the acute rejection, one case died of the cardiac arrhythmia, one case died of the septicemia , the other case died of the hepatic failure. Conclusion In perioperation, the low mortality can be realized by selecting the suitable recipients, using the optimal im-munosuppressive protocols and the management of the complications. In long - term following, the adjustment of the blood Concentration of Cyclosporin and the management of the complications were necessary .