原位心脏移植43例

ORTHOTOPIC HEART TRANSPLANTATION: A CLINICAL ANALYSIS OF 43 PATIENTS

目的 探讨 4 3例同种异体原位心脏移植的初步经验和体会。方法 自 1995年 8月至 2 0 0 3年 5月福建医科大学附属协和医院心外科共为 4 3例终末期心脏病患者实施了原位心脏移植。对这些患者的手术效果及其影响因素进行回顾性总结。结果 术后早期死亡 7例 ,分别死于急性右心功能衰竭 (5例 )、感染 (1例 )和急性肾功能衰竭 (1例 ) ,死亡率为 16 .3% ;晚期死亡 5例 ,分别死于急性排斥反应 (2例 )、感染 (2例 )和心律失常 (1例 )。长期生存的患者生活质量良好。结论 心脏移植是治疗终末期心脏病的有效方法。低肺血管阻力受体的选择和合理的免疫抑制治疗方案的应用是心脏移植成功的关键。

OBJECTIVE TO EXPLORE THE EXPERIENCE OF ORTHOTOPIC HEART TRANSPLANTATION.METHODS BETWEEN AUGUST 1995 AND MAY 2003, 43 PATIENTS WITH END-STAGE HEART DISEASE, 40 MALES AND 3 FEMALES, AGED 13~58, THE UNDERLYING DISEASES BEING OF DILATED CARDIOMYOPATHY (39 CASES), HYPERTROPHIC CARDIOMYOPATHY (3 CASES), AND CORONARY CARDIOPATHY (1 CASE), UNDERWENT ORTHOTOPIC HEART TRANSPLANTATION IN UNION HOSPITAL, FUJIAN MEDICAL UNIVERSITY. THE SURGICAL RESULTS AND RELEVANT INFLUENCING FACTORS WERE STUDIED RETROSPECTIVELY. RESULTS SEVEN CASES DIED OF COMPLICATION WITHIN ONE MONTH POSTOPERATIONALLY, AMONG WHICH 5 DIED OF ACUTE RIGHT HEART FAILURE, 1 OF SEPTICEMIA, AND 1 OF ACUTE RENAL FAILURE, WITH A MORTALITY OF 16.3%. 5 CASES DIED MUCH LATER, AMONG WHICH 2 DIED OF ACUTE REJECTION, 2 OF INFECTION, AND 1 OF ARRYTHMIA. THE LONG-TERM SURVIVORS HAD A RATHER GOOD QUALITY OF LIFE. CONCLUSION HEART TRANSPLANTATION IS AN EFFECTIVE TREATMENT FOR PATIENTS WITH END-STAGE HEART DISEASES. APPROPRIATE SELECTION OF RECIPIENTS WITH LOW PULMONARY VASCULAR RESISTANCE AND PROPER IMMUROSUPPRESSION TREATMENT ARE KEY MEASURES OF SUCCESSFUL HEART TRANSPLANTATION.