心脏移植12例随访观察

目的 观察心脏移植的疗效。方法 随访接受心脏移植的1组患者术后的劳动力、生活质量以及精神和／或肉体的并发症。结果 1997年6月至2002年6月行同种原位心脏移植12例,其中1例为心肾联合移植。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。10例长期生存(83．3％),其中1例于术后7个月在停服霉酚酯酸(骁悉)后死于急性排斥反应;其余9例已生存1～6年,平均3年半。心肾联合移植患者也已生存近3年。这9例患者各自到术后1年时,心功能均达到Ⅰ级,并保持至今,且都已恢复工作。有1例于术后1周曾出现精神分裂症状。生存达1年的9例均作冠状动脉造影,每例均表现冠状动脉变细,侧支减少,有2例于术后4、5年心电图显示左心室前壁或后壁局部缺血,这9例患者临床上均无冠心病症状。2例出现糖尿病。2例在围手术期因渗血第2次开胸。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的血压升高。9例均因此需长期服降压药物控制血压。随访中无恶性肿瘤的出现。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 twelve cases of heart transplantation

OBJECTIVE: To observe the effects of heart transplantation. METHODS: Twelve patients undergoing orthotopic heart transplantation, one of which underwent combined heart and kidney transplantation (HKT), from June 1997 to June 2002 were followed up to observe the complications, work ability, life quality and psychic status. RESULTS: One of the 12 patients died of acute rejection and one died of acute renal failure during perioperative period. Ten cases (83.3%) survived the operation. Then one of the 10 patients died of acute rejection due to stopping Cellcept 7 months after operation; and the other 9 patients had lived well for 1 to 9 years, of which one recipient undergoing HKT survived for nearly 3 years. One year after operation the 9 patients showed class I heart function (NYHA), and all resumed their original work. One patient suffered from schizophrenia 1 week after operation. After the operation every year all cases were to receive coronary angiography with the results showing thinner coronary artery and less lateral branches, and myocardium, emission computed tomography (ECT) scanning that revealed local ischemia in anterior or posterior myocardium in 2 cases 4 and 5 years after respectively, however, no symptom of coronary artery disease was seen in all patients. Two cases, including the one receiving HKT, had symptoms of diabetes mellitus. Two patients thoracotomy during the perioperative period because of cardiac tamponade or too much blood drainage. All cases suffered from right heart failure, mouth ulcer and hypertension due to taking CsA and they had to take antihypertension drug to control their blood pressure. No malignant tumor had been found. CONCLUSION: Heart transplantation is an effective treatment for end-stage dilated cardiomyopathy. But many complications may follow. Some of them may endanger patients' life, and others may affect the quality of life. To trace the patients closely and deal with various complications in time will improve the effect of cardiac transplantation.