CAJ | 학술논문

目的探讨心肺联合移植中供者心、肺的保护措施,以及术后免疫抑制方案、排斥反应的临床诊断及其处理.方法回顾分析2例心肺联合移植的临床资料.2例供肺的灌洗分别使用Perfadx保护液(每1000 ml加入氨基丁三醇0.3 ml,伊洛前列素25 μg)和Euro Collins(EC)保护液(每1000 ml加入氨基丁三醇0.3 ml,前列地尔100 μg).供心的灌洗使用UW液.心肺联合移植采用经典原位技术.免疫抑制方案采用巴利昔单抗诱导,术后采用环孢素A+吗替麦考酚酯+皮质激素.术后早期观察受者的血象变化,各器官功能,各心腔大小及室间隔、左室后壁厚度等,必要时行胸部CT、纤维支气管镜及组织病理检查,及时发现排斥反应征象.受者发生排斥反应后给予皮质激素冲击治疗,并及时调整免疫抑制剂用量.结果 2例受者分别于术后第80天和第141天康复出院,分别随访4年6个月与4年2个月,现生活质量良好.1例受者于术后第10天和第26天发生急性排斥反应,另1例受者于术后第29天和第87天发生急性排斥反应,均经皮质激素冲击治疗,并调整免疫抑制剂用量后逆转.当受者发生急性排斥反应时,往往伴有血象的变化及室间隔和左心室后壁厚度的增加,给予相应治疗后渐恢复至正常范围.结论 Perfadx保护液和EC保护液对供肺均有较好的保护作用,UW液对供心有较好的保护作用;术后及时发现排斥反应与感染,并采取恰当的处理措施有利于受者顺利康复.
목적 탐토심폐연합이식중공자심、폐적보호조시,이급술후면역억제방안、배척반응적림상진단급기처리.방법 회고분석2례심폐연합이식적림상자료.2례공폐적관세분별사용Perfadx보호액(매1000 ml가입안기정삼순0.3 ml,이락전렬소25 μg)화Euro Collins(EC)보호액(매1000 ml가입안기정삼순0.3 ml,전렬지이100 μg).공심적관세사용UW액.심폐연합이식채용경전원위기술.면역억제방안채용파리석단항유도,술후채용배포소A+마체맥고분지+피질격소.술후조기관찰수자적혈상변화,각기관공능,각심강대소급실간격、좌실후벽후도등,필요시행흉부CT、섬유지기관경급조직병리검사,급시발현배척반응정상.수자발생배척반응후급여피질격소충격치료,병급시조정면역억제제용량.결과 2례수자분별우술후제80천화제141천강복출원,분별수방4년6개월여4년2개월,현생활질량량호.1례수자우술후제10천화제26천발생급성배척반응,령1례수자우술후제29천화제87천발생급성배척반응,균경피질격소충격치료,병조정면역억제제용량후역전.당수자발생급성배척반응시,왕왕반유혈상적변화급실간격화좌심실후벽후도적증가,급여상응치료후점회복지정상범위.결론 Perfadx보호액화EC보호액대공폐균유교호적보호작용,UW액대공심유교호적보호작용;술후급시발현배척반응여감염,병채취흡당적처리조시유리우수자순리강복.
Objective To summarize the preservation measures of the donor's heart and lung, and the postoperative immunotherapy, as well as the clinical experience of discrimination and management for graft rejection.Methods The clinical data of 2 cases of heart-lung transplantation in our department were retrospectively analyzed. Two different protective liquids were used for donor's lung lavage of 2 cases: Perfadx solution (1000 mL containing tris 0.3 mL and ilomedin 25 μg); Euro Collins solution (1000 mL containing tris 0.3 mL and PGE1 100 μg). UW solution was used for donor's heart lavage. Surgical procedure for heart-lung transplantation was classic technique in situ. The schedule of immunosuppression was induced by Basiliximab, and combined with cyclosporine+ mycophemolate mofeil+corcal hommone after operation. recipient's blood count, organ's functions, the sizes of every cavity of heart, IVSPW and LVPW were observed during early post-operation. The recipients were subjected to chest CT scan, fiberoptic bronchoscope and tissue pathological study when necessary to find the signs of rejection promptly. When the rejection occurred in the recipient, cortical hormone's impulse therapy was given and the dose of immunosuppression was adjusted in time.Results Two patients discharged in 80 days and 141 days after operation. The patients were followed up for 54 months and 50 months respectively, and their life qualities were very well. Acute rejections occurred on the 10th and 26th day in one case, and in another case, acute rejections occurred on the 29th and 87th day after operation. All were conversed by cortical hormone's impulse therapy and adjusting the dose of immunosuppressants. When acute rejection occurred, the blood count had significant change, and IVSPW and LVPW were increases. They were returned the normal range after corresponding therapy.Conclusion Perfidx solution and Euro-Collin solution may play good protective roles for donor's lungs. UW solution may play good a protective role for donor's heart. To discriminate the clinical graft rejection and infection in time and administrate correct management will have large benefits for the patients' rehabilitation.