重症慢型克山病的治疗-心脏移植(附3例报告)

目的探讨心脏移植对治疗重症慢型克山病的治疗效果。方法对三例重症慢型克山病患者分别行标准术式、全心脏原位移植术、双腔原位心脏移植。移植术中供心保护采用经冠状静脉窦逆行灌注氧合血。术前后系统护理、抗感染、抗排斥反应和对症处理。结果移植吻合时间分别为６５分、７７分和８２分。术后前２例恢复顺利，无并发症。第３例术后右心功能不全，经系统治疗，术后５天好转，２周后出现肺感染系统抗炎后痊愈；术后３个月出现糖尿病，胰岛素治疗后得到控制。３例患者已分别存活近５年、４年余和１年余，心功能均为Ｉ级。结论认为心脏移植是治疗重症慢型克山病的有效措施之一，良好的供心保护、确切的吻合技术、合理应用免疫抑制剂、及时防治术后并发症是提高移植近、远期疗效的重要因素

The therapy of severe chronic Keshan disease:heart transplantation

Objective To evaluate the therapeutic effects of heart transplantation for 3 cases of severe chronic Keshan desease.Methods About operating method for the 3 cases,the first one was standard orthotopic heart transplantation(OHT),the second case was whole heart OHT,the last one was bicaval OHT.The donor hearts were preserved by retrograde blood reperfusion through coronary venous sinus during heart transplantation.Before and after operation,these patients were given intensive nursing,antibiotics,immunosuppressive agents and other symptom treating drug.Results Duration of anastomoses of the patients were 65,77,82 minutes respectively.The early 2 patients recovered quickly without any complications.The third patient had right heart failure exactly after operation,pulmonary infection 2 weeks after operation,and diabetes mellitus 3 weeks after operation.After systemic treatment,including cardiotropic drug,diuretics,vasodilator,antibiotics,and Insulin,above conditions had well controlled.The patients survived with good quality (heart function grade I) more than 5,4,1 years respectively.Conclusions Heart transplantation is an effective therapy for severe chronic Keshan disease.Good donor myocardial preservation,skilled anastomoses technique,properly using immunosuppressive agents,early diagnosis and effective treatment of complications were the important factors for good early and long term survive after heart transplantation.