CAJ | 학술논문

目的总结心肺联合移植的体会.方法 2006年3月23日对1例患有先天性室间隔缺损合并艾森曼格综合征的27岁女性患者施行了心肺联合移植术.术后对患者进行了长期密切监护,采用达利珠单抗进行免疫诱导,以他克莫司(后转换为环孢素A)、霉酚酸酯及糖皮质激素预防排斥反应,并严密监测和控制感染.结果患者术后恢复顺利,未发生严重感染和急性排斥反应,术后109 d痊愈出院.术后1年7个月时,患者自行停用所有免疫抑制剂,2周后出现发热和活动后气促症状,行心脏彩色B型超声波、胸部CT、纤维支气管镜等检查,未发现排斥反应的特异性改变,肺功能检查显示第1秒最大呼气量为0.54,根据患者症状仍高度怀疑移植肺发生排斥反应,给予甲泼尼龙冲击治疗3 d,然后以泼尼松持续治疗1个月,维持血环孢素A浓度为0.1664～0.3328 μmol/L(0.2～0.4 mg/L),霉酚酸酯用量由0.5 g/d调整到1 g/d,同时行抗感染治疗,2周后患者症状消失.术后2年时,行纤维支气管镜肺活检,未见闭塞性细支气管炎综合征.术后2年5个月时,冠状动脉造影检查显示冠状动脉无狭窄,检测心功能正常.至2009年5月,患者已存活3年余.结论重视供、受者的HLA配型,合理有效的预防排斥反应方案和感染的有效控制是心肺联合移植术成功的关键.
목적 총결심폐연합이식적체회.방법 2006년3월23일대1례환유선천성실간격결손합병애삼만격종합정적27세녀성환자시행료심폐연합이식술.술후대환자진행료장기밀절감호,채용체리주단항진행면역유도,이타극막사(후전환위배포소A)、매분산지급당피질격소예방배척반응,병엄밀감측화공제감염.결과 환자술후회복순리,미발생엄중감염화급성배척반응,술후109 d전유출원.술후1년7개월시,환자자행정용소유면역억제제,2주후출현발열화활동후기촉증상,행심장채색B형초성파、흉부CT、섬유지기관경등검사,미발현배척반응적특이성개변,폐공능검사현시제1초최대호기량위0.54,근거환자증상잉고도부의이식폐발생배척반응,급여갑발니룡충격치료3 d,연후이발니송지속치료1개월,유지혈배포소A농도위0.1664～0.3328 μmol/L(0.2～0.4 mg/L),매분산지용량유0.5 g/d조정도1 g/d,동시행항감염치료,2주후환자증상소실.술후2년시,행섬유지기관경폐활검,미견폐새성세지기관염종합정.술후2년5개월시,관상동맥조영검사현시관상동맥무협착,검측심공능정상.지2009년5월,환자이존활3년여.결론 중시공、수자적HLA배형,합리유효적예방배척반응방안화감염적유효공제시심폐연합이식술성공적관건.
Objective To summarize the heart-lung transplantation (HLT) experience. Methods One case of ventricular septal defect of congenital heart disease with Eisenmenger syndrome,a 27-year-old female, underwent HLT on March 23,2006. Postoperatively the patient received guardianship of a long close,and induction therapy is applied with monoclonal antibodies. Rejection was prevented with Tacrolimus (converted to cyclosporine A later), mycophenolate mofetil (MMF), corticosteroids.Infection was monitored and controlled. Results The patient survived after the operation. No severe infection or acute rejection occurred. The postoperative hospital stay was 109 days. The patient has been alive till now for 3 years and 1 month. One year and 7 months after operation, the patient terminate immunosuppressive therapy by herself, and 2 weeks later hypoxia and low-grade fever occurred. Heart color B type ultrasound, chest CT scan, and the fiberoptic bronchoscopy did not reveal rejection-specific changes. Forced expiratory volume in 1 second was 0. 54. The symptoms still occurred on the height of suspected lung transplant rejection. Methylprednisolone was administered (500 mg×3 days), and the patient received oral prednisone for one month. Cyclosporine A was adjusted to maintain through blood levels of 0. 1664-0. 3328 μmol/L (0. 2-0.4 mg/L) ,MMF dosage was adjusted from 0.5 to 1 g/day,and at the same time the anti-infective therapy was done. Two weeks later the symptoms disappeared. Two years after operation, lung biopsy by the fiberoptic bronchoscopy did not show bronchiolitis obliterans syndrome. Two years and 5 months after operation, coronary angiography indicated that there was no stenosis of coronary artery, and cardiac function was normal. Conclusion The success of HLT is based on human leukocyte antigen (HLA) matching, reasonable organ preservation, careful surgical procedures, strict preventive measures against infection and immunosuppressive management.