心脏移植围手术期处理的临床分析
|
摘要
目的：总结心脏移植围手术期处理的临床经验，探讨心脏移植围手术期受体适应症的选择，不同免疫诱导治疗方案的优缺点以及各种并发症的处理，提高围手术期手术的成功率，降低死亡率。
方法：回顾性分析了1995年8月至2003年3月间共38例同种异体原位心脏移植病例，对其治疗经验和随访结果进行分析总结。
结果：本组38例受体术后早期(1月内)死亡6例，死亡率15.8％，手术成功率84.2％，6例死亡病例中有4例死于术后急性右心功能衰竭，1例死于败血症，1例因急性肾功能衰竭死于多器官功能衰竭。在围手术期仅1例受体发生急性排斥反应，有5例受体发生移植性糖尿病。4例受体发生急性肾功能衰竭，这4例受体中有2例行持续肾脏替代治疗(Continuous renal replacement therapy,CRRT)存活，1例受体同期行肾移植存活，1例受体行血液透析治疗死于多器官功能衰竭。
结论：心脏移植是治疗各种终末期心脏病最有效的方法，在手术早期为了提高手术的成功率，降低死亡率，必须重视围手术期对受体适应症的选择、选择合理的免疫抑制治疗方案以及对各种并发症尤其是急性肾功能衰竭的处理。
[Objective] TO review the experience of the perioperative management in heart transplantation.
[ Methods] 38 records were studied retrospectively for analysis of the experience. [ Results ] 6 cases died of complications in perioperation, 4 of 6 cases died of the acute right heart failure, one case died of the multiple organ dysfunction., one case died of the septicemia. The mortality was 15.8%, the survival was 84.2%. In perioperation one case suffered from acute rejection, 5 cases had post-transplant diabetes mellitus ( PTDM ). 4 of 38 cases suffered from acute renal failure in prioperation, 2 of 4 cases received the continuous renal replacement therapy (CRRT), one of 4 cases had the cardionephric transplantation, the other received the hemodialysis and died of the multiple organ dysfunction.
[Conclusion] The low mortality can be realized by selecting the suitable recipients, using the optimal immunosuppressive protocols and the management of the complications.
方法：回顾性分析了1995年8月至2003年3月间共38例同种异体原位心脏移植病例，对其治疗经验和随访结果进行分析总结。
结果：本组38例受体术后早期(1月内)死亡6例，死亡率15.8％，手术成功率84.2％，6例死亡病例中有4例死于术后急性右心功能衰竭，1例死于败血症，1例因急性肾功能衰竭死于多器官功能衰竭。在围手术期仅1例受体发生急性排斥反应，有5例受体发生移植性糖尿病。4例受体发生急性肾功能衰竭，这4例受体中有2例行持续肾脏替代治疗(Continuous renal replacement therapy,CRRT)存活，1例受体同期行肾移植存活，1例受体行血液透析治疗死于多器官功能衰竭。
结论：心脏移植是治疗各种终末期心脏病最有效的方法，在手术早期为了提高手术的成功率，降低死亡率，必须重视围手术期对受体适应症的选择、选择合理的免疫抑制治疗方案以及对各种并发症尤其是急性肾功能衰竭的处理。
[Objective] TO review the experience of the perioperative management in heart transplantation.
[ Methods] 38 records were studied retrospectively for analysis of the experience. [ Results ] 6 cases died of complications in perioperation, 4 of 6 cases died of the acute right heart failure, one case died of the multiple organ dysfunction., one case died of the septicemia. The mortality was 15.8%, the survival was 84.2%. In perioperation one case suffered from acute rejection, 5 cases had post-transplant diabetes mellitus ( PTDM ). 4 of 38 cases suffered from acute renal failure in prioperation, 2 of 4 cases received the continuous renal replacement therapy (CRRT), one of 4 cases had the cardionephric transplantation, the other received the hemodialysis and died of the multiple organ dysfunction.
[Conclusion] The low mortality can be realized by selecting the suitable recipients, using the optimal immunosuppressive protocols and the management of the complications.
引文
1、Marshall I. Hertz, MD, Paul J. Mohacsi, MD, Mark M. Boucek, MD et al. The Registry of the International Society of Heart and Lung Transplantation: Past, Present and Future. J Heart Lung Transplant 2002; 27: 945-949.
2、夏求明，主编．现代心脏移植．第1版．北京：人民卫生出版社，1998，87-89
3、翁钦永，戴茹平，陈存荣，等．心内直视手术中急性等容性血液稀释放血量与红细胞压积变化的关系．中华胸心血管外科杂志 2001；17：339．
4、廖崇先，李增棋，陈道中，等．心脏移植治疗晚期扩张型心肌病七例报告．中华器官移植杂志．1999；20：79-81．
5、Hosenpud JD, Bennett LE, Keck BM, et al. The registry of the international society for heart and lung transplantation: sixteenth official report-1999. J Heart Lung Transplantation 1999; 18: 611-626.
6、Ainat Beniaminovitz, M. D, Silviu Itescu, M. D, Katherine Lietz, M. D, et al. Prevention of Rejection in Cardiac Transplantation by Blockade of the Interleukin-2 Receptor with a Monoclonal Antibody. N Engl J Med 2000; 342: 613-619.
7、Fleischer KJ, Baumgartner WA. Heart transplantation. In: Henry Edmunds L. Cardiac Surgery in the Adult. N Y: McGraw-Hill, 1997; 18: 1409-1449.
8、Martin Hulsmann, MD, Thomas Stefenelli, MD, Rudolf Berger, MD, et al. Response of right ventricular function to prostaglandin E1 infusion predicts outcome for severe chronic heart failure patients awaiting urgent transplantation. J Heart Lung Transplant 2002; 19: 939-945.
9、Hakin M, Wallwork J, English T. Cyclosporine A in cardiac transplantation. Medium-result in 62 patients. Ann Thorac Surg 1998; 46: 495-501.
10、Coopersmith, CM, Brennan, DC, Miller, B. et al. Renal transplantation following previous heart, liver, and lung transplantation: an 8-year single-center experience. Surgery. 2001: Sep.
11、Maria Rosa Costanzo. New immunosuppressive drugs in heart transplantation. Curr Control Trials Cardiovasc Med. 2001; 2(1): 45-53.
12、胡小琴，主编．心血管麻醉及体外循环．第1版．北京：人民卫生出版社，1997．364-365．
13、G. Viberti. Diabetes Mellitus: A Major Challenge in Transplantation, Transplant Proc 2001; 133: 3s-6s.
2、夏求明，主编．现代心脏移植．第1版．北京：人民卫生出版社，1998，87-89
3、翁钦永，戴茹平，陈存荣，等．心内直视手术中急性等容性血液稀释放血量与红细胞压积变化的关系．中华胸心血管外科杂志 2001；17：339．
4、廖崇先，李增棋，陈道中，等．心脏移植治疗晚期扩张型心肌病七例报告．中华器官移植杂志．1999；20：79-81．
5、Hosenpud JD, Bennett LE, Keck BM, et al. The registry of the international society for heart and lung transplantation: sixteenth official report-1999. J Heart Lung Transplantation 1999; 18: 611-626.
6、Ainat Beniaminovitz, M. D, Silviu Itescu, M. D, Katherine Lietz, M. D, et al. Prevention of Rejection in Cardiac Transplantation by Blockade of the Interleukin-2 Receptor with a Monoclonal Antibody. N Engl J Med 2000; 342: 613-619.
7、Fleischer KJ, Baumgartner WA. Heart transplantation. In: Henry Edmunds L. Cardiac Surgery in the Adult. N Y: McGraw-Hill, 1997; 18: 1409-1449.
8、Martin Hulsmann, MD, Thomas Stefenelli, MD, Rudolf Berger, MD, et al. Response of right ventricular function to prostaglandin E1 infusion predicts outcome for severe chronic heart failure patients awaiting urgent transplantation. J Heart Lung Transplant 2002; 19: 939-945.
9、Hakin M, Wallwork J, English T. Cyclosporine A in cardiac transplantation. Medium-result in 62 patients. Ann Thorac Surg 1998; 46: 495-501.
10、Coopersmith, CM, Brennan, DC, Miller, B. et al. Renal transplantation following previous heart, liver, and lung transplantation: an 8-year single-center experience. Surgery. 2001: Sep.
11、Maria Rosa Costanzo. New immunosuppressive drugs in heart transplantation. Curr Control Trials Cardiovasc Med. 2001; 2(1): 45-53.
12、胡小琴，主编．心血管麻醉及体外循环．第1版．北京：人民卫生出版社，1997．364-365．
13、G. Viberti. Diabetes Mellitus: A Major Challenge in Transplantation, Transplant Proc 2001; 133: 3s-6s.