心脏移植及术后随访

目的 总结3例心脏移植的初步经验.方法 3例扩张性心肌患者进行了双腔静脉法的同种原位心脏移植,围手术期间给予受体的维护、供心离体时间长的保护、血流动力学的支持、抗排异反应及感染方面的处理.结果 3例患者均存活,心功能由Ⅳ级提高到Ⅰ、Ⅱ级,分别随访19、28、49个月,2例因未正常服药发生排异反应.结论 选择合适的供体和受体、良好的供心保护技术、有效的血流动力学支持、抗排异反应方案得当、防止感染是围手术期处理的重要组成部分,是手术成功的关键.正规服用抗排异药物是避免或减少排异反应的基本条件.

Heart transplantation and follow-up

Objective To share the experience of heart thransplantation. Methods 3 recipients with terminal myocardiosis were reviewed. The transplantation was performed with inferior and superior vena anastomofic technique. During perioperative period, we selected and maintained the recipients, protected donor-isolated heart, supported circulation,decreased immune reaction and controlled infections. Results All the 3 patients survived. Heart function improved from NYHA class 1V before heart transplant to NYHA class Ⅰ, Ⅱ. The follow-up time was 19 months ,28 months and 49 months respectively. Rejection occurred in two cases due to non-compliance to medication. Conclusions Suitable recipient, proper donor heart procurement and preservation, suitable maintenance of circulation, proper managements of anti-immunitive reaction, prevention of infections are critical for successfal heart transplantation. Medicine-take required may avoid or reduce rejection.