一例同种异体部分颜面移植围手术期免疫抑制治疗方案

目的探讨同种异体颜面复合组织移植术在围手术期的免疫抑制方案和其他用药治疗措施，以期为同种异体颜面移植术探索一条行之有效的药物治疗方案。方法对一例同种异体颜面移植患者围手术期的药物治疗进行系统观察。免疫抑制治疗采用FK506、霉酚酸酯（MMF）、激素（Pred）、赛尼哌四联免疫抑制方案；并应用各种抗感染药物预防细菌、病毒和真菌感染，同时应用奥美拉唑、肝泰乐等药物保护胃肠和肝肾功能。通过观察移植物术后的色泽、肿胀情况、及血液中T细胞分化抗原（CD）系列和病理学等指标，观察免疫排斥情况；通过观察患者的症状、体征，及肝肾功能、血常规等各种化验指标，监测免疫抑制剂的不良反应和各种并发症，并及时调整用药方案和剂量，以免对患者造成永久性伤害。结果移植的复合组织瓣在围手术期血运良好，皮肤色泽正常，术后1周后开始消肿，半个月后恢复正常。于1个月内多次分析血液中辅助T淋巴细胞（Th，CD3＋、CD4＋）和抑制T淋巴细胞（Ts，CD3＋、CD8＋），未发现异常。病理切片未显示急性排异反应的指征。在围手术期，除在冲击治疗过程中有一过性的血糖升高外，未发现各种药物的不良反应和身体机能的损伤。结论本例异体颜面移植患者应用四联免疫抑制方案和其他辅助用药，有效地控制了急性排异反应，在各种辅助用药的支持下，平安地渡过了危险期。

Immunosuppressive treatment about the patient operated facial allotransplantation in perioperative period

Objective To investigate the perioperation medication on the first patient who was operated facial allotransplantation, including immunosuppressive drug and adjunctive drug, so that to search a effective medication schedule to the patient operated facial allotransplantation. Methods FK506, MMF, Prednisone and Zenopax was performed as immunosuppressive regiment in perioperative treatment; meanwhile, anti-infectives was administered to take precautions against all sorts of infections, such as bacterium, virus and fungus. Furthermore, all kinds of adjunctive drug,Losec, glucurolactone and so on, was administered to protect those function of stomach, liver, kidney and so on. Clinical observations were made on the signs and symptoms of graft survival or rejection, as well as immunological indexes were tested in laboratory. Biopsies of graft were also made at 30 d after operation. Side effect and complication of drug was monitored, in case the body suffered harm. Results Facial allograft was survived, and the temperature and color of skin were normal. Swelling of tissue was gradually subsidise after 4 days, and recovered in a half month. The count and ratio between Th and Ts were normal, skin Biopsies of every time had no found of hyperacute or acute rejection, and side effect and complication of drug had no monitored. Conclusions The regiment of perioperation medication was successfully performed.