心脏移植17例随访观察

目的观察心脏移植的疗效。方法1997年6月至2009年8月行同种原位心脏移植17例，其中1例为心肾联合移植。随访接受心脏移植患者术后的劳动力、生活质量以及精神和（或）身体的并发症。结果2例围手术期死亡，原因分别为急性排斥反应和急性肾功能衰竭。另有2例分别于术后7个月和术后2年半因停服免疫抑制药物而引发急性排斥反应死亡。另1例为ABO血型不合者．在术后6个月因急性排斥反应死亡。长期生存11例，其中4例已生存10年余。心肾联合移植患者也已生存近9年。除最近1例（正在康复中），其余11例术后半年心功能均达到Ⅰ级，并保持至今，且均已恢复工作。前9例生存达1年的患者均作冠状动脉造影，每例均表现冠状动脉变细，侧支减少，有4例于术后4、5年心肌ECT扫描显示左心室前壁或后壁局部缺血，但这些生存者临床上均无冠心病症状。2例出现糖尿病。术后早期每例均有不同程度的右心功能不全、口腔溃疡及服用环孢素后血压升高。11例均因此需长期服降压药物控制血压。第一例患者术后12年出现恶性淋巴瘤，用CHOP方案化疗2个疗程后完全缓解。结论心脏移植是治疗终末期扩张型心肌病的有效方法，但术后可能发生的并发症较多，有的影响生活质量，有的甚至可危及生命。术后密切的随访，预防并及时发现和处理并发症将有助于提高疗效。

Follow-up of 17 cases of heart transplantation

Objective To review the outcomes of patients with heart transplantation. Methods Seventeen patients underwent orthotopic allogeneous heart transplantation, including 1 case of combined heart and kidney transplantation （HKT）, from June 1997 to August 2009 were followed up. The complications, work ability, quality of life and psychic status of patients were reviewed. Results Two cases died perioperatively, including one from acute rejection and one from acute renal failure; two cases died in 7-30 months after operation from acute rejection due to withdrawal of immune depressants, one ABO-incompatible patient died of acute rejection 6 months after operation. The remaining 11 patients had long-term survival, including 4 for more than 10 years; one HKT case survived for nearly 9 years. All 11 surviving patients showed class I heart function （NYHA） and resumed to work. Nine patients who survived more than 1 year received coronary angiography showing thinner coronary artery and less lateral branches. Emission computed tomography （ECT） scan revealed local ischemia in anterior or posterior myocardium in 4 patients who had operation 4 N 5y before, however, no symptoms of coronary artery disease were found. Two cases, including one HKT, had symptoms of diabetes mellitus. All cases suffered from right heart failure, oral ulcer and hypertension due to taking cyclosporin and had to take antihypertensive drugs to control blood pressure. The first case in this series was found to have malignant lymphoma 12y after operation and had remission after 2 courses of chemotherapy （CHOP）. Conclusion Heart transplantation is an effective treatment for end-stage dilated cardiomyopathy. To improve the outcomes of transplantation it is necessary to follow up the patients closely and manage various complications timely.