移植心冠状动脉增殖性心脏病的预防与监测

目的　观察心脏移植患者冠状动脉增殖性病变的发病情况。方法　对 5例长期存活的心脏移植受者进行了观察。患者在心脏移植后使用祛脂药、血管紧张素转换酶抑制剂及硝酸酯类药 ,观察心电图ST T改变、临床症状 (如胸痛等 )、血压、血糖、血脂 ,并行冠状动脉造影。结果　 5例患者术后各发生急性排斥反应 1～ 3次 ,均出现心电图多个导联T波倒置及ST段轻度下移 ,1年后ST T改变恢复正常 ,1例患者血糖长期升高 ,1例血脂升高 ,2例出现血压升高 ,冠状动脉造影均未发现冠状动脉狭窄。结论　对长期存活的心脏移植患者应注意冠状动脉增殖性病变的预防与监测 ,定期行冠状动脉造影有重要的临床意义。

Protection and monitoring of the donor heart coronary proliferation

Objective To explore the protective and monitoring methods for the donor heart coronary proliferative disease of the long-term survivals of heart transplantation.Methods Five long-term survivors of heart transplantation were studied.Each patient administered angiotensin converting enzyme inhibitors,nitrates and pravastatin after the cardiac transplantation.The relationship between ECG ST-T changes,clinical symptoms(such as chest pain,etc.),hypertension,hyperglycemia,hyperlipemia and coronary angiography were studied.Results Five cardiac transplants received corollary angiography 6,4,3.1 and 1 years after heart transplantation.No coronary stencxsis was found.Conclusions Hypertension,hyperglycemia and hyperlipemia might not be the"risk factors"for the donor heart coronary proliferative disease.The chest pain and ECG ST-T changes didn't suggest the insufficiency of coronary blood supply.Periodical coronary angiography had a significantly clinical value.