同种异体原位心脏移植术后的监测治疗

目的总结昆明市延安医院云南省心脏移植中心11例同种异体原位心脏移植术后的监测治疗。方法选择2003年3月—2008年9月进行同种异体原位心脏移植术患者11例,手术均按标准法行同种异体原位心脏移植,术后抗排斥反应治疗采用环孢素(CsA)+霉酚酸酯(MMF)+泼尼松(Pred)三联方案,并给予严密的监测治疗。结果 11例患者均一期恢复良好出院,出院后6例患者存活至今,心理状态良好,血流动力学稳定,无明显免疫排斥迹象;3例患者死亡,其中1例因患者自己暗地里不规律服用免疫抑制药物引起急性排斥反应,经我科救治好转后出院,仍然不规律服用免疫抑制药物而猝死家中,1例肺部严重感染,1例急性右心衰竭经再次入院抢救,无效死亡。结论心脏移植是目前终末期心脏病最有效的治疗手段,术后的监测治疗十分关键。     

心脏移植后的移植性血管病

本文描述了心脏移植后的移植性血管病的流行病学、病理解剖、危险因素和病理生理及诊断，简要地介绍了国外常用的预防和治疗方法。     

趋化因子与心脏同种异体移植血管病变的研究进展

形成心脏同种异体移植血管病变的中心事件是免疫和非免疫因素导致内皮功能受损之后的炎症反应。近来,越来越多的研究表明趋化因子在心脏同种异体移植血管病变的发生中起重要作用。     

移植心脏血管病研究进展

移植心脏血管病研究进展［ＶｅｎｔｕｒａＨＯ，Ｍｅｈｒａ　ＭＲ，Ｓｍａｒｔ　ＦＷ，ｅｔａｌ．ＡｍＨｅａｒｔＪ，１９９５，１２９（４）：７９１（英文）］移植心脏血管病（Ｃａｒｄｉａｃａｌｌｏｇｒａｆｔｖａｓ－ｃｕｌｏｐａｔｈｙ，ＣＡＶ）通常又称为移植心脏...     

同种异体半月板移植进展

半月板在膝关节复杂的生物力学结构中发挥着至关重要的作用。随着治疗经验的积累,半月板损伤的治疗也有了新的观念,即半月板损伤后优先考虑缝合手术;仅切除病损部分,最大程度保留半月板;在关节镜下手术;开发半月板移植和替代手术。同种异体半月板移植最有可能在临床广泛应用。半月板移植能缓解半月板全切后的疼痛,防止关节软骨及的软骨下骨变性改变,防止或减少骨关节炎发生的危险性和重建力学平衡。近几年来国内外对半月板移植研究较多。现综述如下。     

同种异体静脉移植实验和临床研究进展

血管重建术是血管外科临床的主要治疗手段。尤其在我国静脉疾病具有很高的发病率,特别是对下肢深静脉血栓形成后综合征和原发性深静脉瓣膜病因无理想的静脉替代品多以保守治疗为主。然而,目前布—加氏综合征、上下腔静脉阻塞综合征、下肢深静脉阻塞和瓣膜功能不全多采用人工血管移植、静脉瓣成形术、自体静脉移植等。人工血管价格昂贵且易形成血栓而致通畅率低,静脉瓣成形效果亦欠佳。自体静脉因有较高的通畅率一直是首选材料。自体静脉常因已用于冠脉、周围动脉重建以及因静脉本身病变、口径不符等已渐难于满足临床需要。同种异体静脉具有…     

1例高龄同种异体原位心脏移植患者的术后监测与管理

患者男,65岁,体重50kg。术前诊断为终末期扩张性心肌病、左室增大、窦性心律、心功能Ⅳ级（NYHA分级）。吸烟史30a,每日20支;慢性支气管炎、肺气肿史10a;脊柱侧弯史20a。术前超声心动图检查示扩张性心肌病改变,左室缩短率16％,射血分数（EF）32％,肺动脉压28mmHg。     

埃德蒙顿方案后的同种异体人胰岛移植进展

2000年Shapiro等[1]报告了被称为“埃德蒙顿方案”（Edmonton Protocol）的胰岛移植研究成果.他们对7例有严重低血糖史和代谢不稳定的1型糖尿病病人成功进行了胰岛移植,平均随访11.9个月（4.4～14.9个月）,病人术后均不需胰岛素治疗,未再发生严重低血糖.     

同种异体心肌细胞移植治疗缓慢性心律失常的实验研究

探讨新生心肌细胞移植重建心脏优势起搏点治疗缓慢性心律失常的可行性。采用酶法分离新生Yorkshire猪右房组织(包括窦房结),获取单个心肌细胞,差速贴壁法纯化,4,6-二脒基-2-苯基吲哚(DAPI)标记后制备成5×106个/ml心肌细胞悬液,开胸直视下将1ml悬液注入细胞移植组幼年猪左室游离壁(n=5),对照组(n=5)注入等体积培养基,移植前3天开始应用环孢素A和泼尼松龙抑制免疫排斥反应。移植3周后应用射频消融技术打断His束造成Ⅲ度房室阻滞。分别应用心电图、Holter、心腔内起搏标测和免疫荧光显像进行电生理学评价和组织学观察。结果:His束消融后,两组动物均形成Ⅲ度房室阻滞。细胞移植组室性节律频率显著快于对照组(移植组平均为95次/分,对照组为32次/分)。心腔内起搏标测证实细胞移植组室性心律起源于细胞移植区。对照组均在24h内发生心室颤动死亡。心脏组织冰冻切片可见DAPI标记的呈蓝色荧光的移植细胞核,移植细胞与宿主心肌细胞间有连接蛋白43和N型钙粘素的表达。结论:移植的心肌细胞可在宿主心脏存活并与周围细胞发生电连接,并主导心室节律。     

同种异体胰岛移植免疫耐受的诱导

同种异体胰岛移植为1型糖尿病患者带来了治愈疾病的希望,临床应用的成功显示了胰岛移植良好的发展前景。但移植后患者需终身服用免疫抑制剂,使胰岛移植仅适合用药物难以控制的糖尿病或需进行肾移植的患者。显然,诱导免疫耐受无疑将大大扩展胰岛移植的指征,更多的1型糖尿病患者将从中得益,避免糖尿病远期并发症的发生并提高生活质量。本文综述了诱导免疫耐受、延长同种异体移植胰岛存活的最新实验进展,包括外周和中央型耐受的诱导。对一些细胞表面分子,如共刺激分子、黏附素及细胞因子受体等进行干预,均可延长移植于非自身免疫疾病背景小鼠的同种异体胰岛存活时间。去除同种异体反应性T细胞、诱导供体特异的调节性T细胞是建立外周耐受的重要途径,甚至对有抵抗耐受倾向的自身免疫性非肥胖糖尿病小鼠也有效。通过骨髓移植,结合无须清除原始粒细胞的方案,能获得造血细胞嵌合,使胰岛成功移植于自身免疫性糖尿病受体中,并尽可能减少移植物抗宿主疾病的发生。     

Open-chest management after heart transplantation

Postcardiotomy open-chest management has been widely used in cardiac surgery. Although this strategy can be applied to heart transplantation, the use of immunosuppressants in transplant recipients raises particular concerns about sternal wound infection and impaired healing.We performed a retrospective review of 403 patients who had undergone 410 heart transplantations at our institution from 1985 through 2004. Among them, 9 patients (2.2%) had open-chest management postoperatively. There were 8 men and 1 woman, with a mean age of 58 +/- 7 years. The graft ischemic time ranged from 130 to 374 minutes (mean, 218 +/- 99 min), and the cardiopulmonary bypass time ranged from 98 to 360 minutes (mean, 210 +/- 69 min). In all cases, the reason for open-chest management was hemodynamic lability that precluded chest closure after transplantation. One patient also experienced postoperative bleeding. All patients underwent delayed sternal closure between postoperative days 1 and 11 (median, 4 days). Delayed sternal closure did not cause any significant hemodynamic changes. One patient died of stroke on postoperative day 22. No patient had sternal wound infection or impaired wound healing during the follow-up period.We conclude that, when required, open-chest management is an effective and safe measure for hemodynamically unstable heart transplant patients.     

Gastroenterologic findings in graft versus host disease after allogenic bone marrow transplantation

We are reporting on a 25 years old patient with acute myelogenous leukemia, who developed an acute graft-versus-host disease (GVHD) 43 days after allogeneic bone marrow transplantation (BMT). The clinical symptoms included exanthema, diarrhea and abdominal cramps. The patient was treated with cyclosporine A and prednisone and the clinical symptoms disappeared subsequently. At day 225 post BMT the patient became icteric as the clinical manifestation of chronic GVHD. We describe in this case report endoscopical and histological findings during the episodes of acute and chronic graft-versus-host disease. The results obtained by sigmoidoscopy and liver biopsy confirmed the clinical diagnosis. The clinical work up of patients with acute or/and chronic GVHD should also include sigmoidoscopy in order to verify this transplantation related complication.     

Long-term follow-up and management guidelines in pediatric patients after allogenic hematopoietic stem cell transplantation

Over the past 50 years there has been considerable progress and success in the field of allogeneic hematopoietic stem cell transplant (HSCT) in children. In addition there has been significant improvement in transplant outcomes for both malignant and nonmalignant indications. These improved outcomes have resulted in many long-term survivors who are experiencing substantial long-term morbidities. There are limited data examining the long-term complications of transplant on the various organs. This issue is complicated by the fact that children receive their transplant at different stages of their growth and development (ie, infant, toddler, child, adolescent, and young adult). Each of these developmental stages has different sensitivities to treatment and can result in different sets of complications. We summarize the long-term side effects of allogeneic HSCT in children.     

Impact of pulmonary vascular resistances in heart transplantation for congenital heart disease

Congenital heart disease is one of the major diagnoses in pediatric heart transplantation recipients of all age groups. Assessment of pulmonary vascular resistance in these patients prior to transplantation is crucial to determine their candidacy, however, it is frequently inaccurate because of their abnormal anatomy and physiology. This problem places them at significant risk for pulmonary hypertension and right ventricular failure post transplantation. The pathophysiology of pulmonary vascular disease in children with congenital heart disease depends on their pulmonary blood flow patterns, systemic ventricle function, as well as semilunar valves and atrioventricular valves structure and function. In our review we analyze the pathophysiology of pulmonary vascular disease in children with congenital heart disease and end-stage heart failure, and outline the state of the art pre-transplantation medical and surgical management to achieve reverse remodeling of the pulmonary vasculature by using pulmonary vasodilators and mechanical circulatory support.     

Prevention and management of CMV-related problems after hematopoietic stem cell transplantation

Prevention and management of human cytomegalovirus (CMV) infection after hematopoietic stem cell transplantation has improved substantially in the past decade. However, with this improvement, there is increased complexity in deciding which diagnostic tests, treatment strategies and immunologic assessments are optimal for different patient populations. The purpose of this review is to address certain practical problems that commonly arise and suggest a suitable approach to management that should have wide applicability.     

单倍体骨髓移植后巨细胞病毒感染的防治

目的:研究单倍型骨髓移植后,巨细胞病毒(CMV)感染的预防策略及发病情况。方法:98例单倍型骨髓移植患者,62例及1例CMVpp65阳性供者,接受更昔若韦预防治疗,受者5 mg／kg,2次／d,移植前-9 d～-2 d,31例移植后出现CMV抗原血症阳性患者,其中18／60例预防组,13／35例非预防组阳性病例,接受更昔若韦5 mg／kg,2次／d×2周,后改为5 mg／kg,1次／d,到CMVpp65转阴。移植后CMVpp65每周检测1次。结果:预防组18／60例移植后出现CMV抗原血症阳性,出现中位时间56(25～84)d。非预防组13／35例CMVpp65阳性,中位时间52(19～75)d,前者1例患者(1．6％)发展为CMV结肠炎,后者4例(11．4％),2例CMV肺炎,1例CMV结肠炎,1例CMV脑炎。结论:单倍型骨髓移植后,用CMVpp65检测CMV抗原血症是一种简便,可靠的方法。低剂量短疗程,静脉注射更昔若韦提前预防CMV病可能是一种有效的方法。