CAJ | 학술논문

目的寻找可靠的非侵入无创性手段监测或诊断排异反应,研究无创监测技术在心脏移植术后急性排异反应监测中的安全性和有效性.方法 2001年4月至2013年6月,31例终末期心脏病患者接受了同种异体原位心脏移植手术.术中麻醉后用甲泼尼龙琥珀酸钠500 mg抗排异治疗,主动脉开放前给予甲泼尼龙琥珀酸钠500 mg抗排异反应.术后抗排异采用新三联疗法:环孢素(CsA)或FK506+强的松+骁悉.2009年以来术中、术后第4天分别用一次舒莱.术后监测急性排异反应手段主要依靠临床症状与体征、心电图、超声心动图、X线影像和心肌酶谱.联合诊断急性排异反应.结果全组共3例死亡(9.7％)(均为肺动脉高压、右心衰继发肾、肺等多脏器衰竭).28例顺利康复出院,随访期间1例于术后1.5年死于霉菌感染.1例术后2个月、1例术后4年发生一次急性排异反应,均经甲强龙冲击治疗后,症状减轻,各项指标迅速好转,未进行心内膜活检.其余26例患者均未出现急性排异反应.1例术后12年肾功能衰竭需要血透治疗.结论采用非侵入无创性监测技术联合诊断监测急性排异反应,敏感、安全、可靠、无创伤和可重复,可作为心脏移植患者抗排异疗效观察的依据.而围术期及术后积极、合理的抗排异治疗方案是减少急性排异反应的前提.
목적 심조가고적비침입무창성수단감측혹진단배이반응,연구무창감측기술재심장이식술후급성배이반응감측중적안전성화유효성.방법 2001년4월지2013년6월,31례종말기심장병환자접수료동충이체원위심장이식수술.술중마취후용갑발니룡호박산납500 mg항배이치료,주동맥개방전급여갑발니룡호박산납500 mg항배이반응.술후항배이채용신삼련요법:배포소(CsA)혹FK506+강적송+효실.2009년이래술중、술후제4천분별용일차서래.술후감측급성배이반응수단주요의고림상증상여체정、심전도、초성심동도、X선영상화심기매보.연합진단급성배이반응.결과 전조공3례사망(9.7％)(균위폐동맥고압、우심쇠계발신、폐등다장기쇠갈).28례순리강복출원,수방기간1례우술후1.5년사우매균감염.1례술후2개월、1례술후4년발생일차급성배이반응,균경갑강룡충격치료후,증상감경,각항지표신속호전,미진행심내막활검.기여26례환자균미출현급성배이반응.1례술후12년신공능쇠갈수요혈투치료.결론 채용비침입무창성감측기술연합진단감측급성배이반응,민감、안전、가고、무창상화가중복,가작위심장이식환자항배이료효관찰적의거.이위술기급술후적겁、합리적항배이치료방안시감소급성배이반응적전제.
Objective To evaluate the effect and safety of noninvasive monitoring during episodes of acute rejection after heart transplantation.Methods Since April 2001 to June 2013,totally 31 homogeneous orthotopic heart transplants were performed.During the operation,500 mg methylprednisolone sodium succinate was used for anti-rejection treatment after anaesthesia.In order to avoid the acute rejection,another 500 mg methylprednisolone sodium succinate was given before aortic-clamp opened.After the operation,we choose a new triple therapy as the standard of anti-rejection treatment after the heart transplantation.CsA or FK506,prednisone metacortandracin and the CellCept.Since 2009,Simulect was used during the operation and the forth day after the operation.Acute rejection after transplantation was monitored by noninvasive monitoring including clinical features,body surface electrocardiogram,echocardiography,thoracic radiograph,and myocardial enzymogram.Results Among all the patients,3 cases (9.7％) died of the pulmonary hypertension,and right heart failure secondary to multiple organ failure such as the kidney or pulmonary; 28 patients of the group had a quick recovery and discharge,and one of them die of fungal infection about one and a half years after the operation.Two patients had acute rejections,the first one was happened two months postoperation and another was about four years later,both of them were relieved by using a large amount of methylprednisolone,all the clinical index took a turn for the better.The acute rejection did not happen to the other 26 patients after the heart transplantation.One patient took a chronic hemodialysis because of the renal failure 12 years after the surgery.Conclusions Noninvasive monitoring was a sensitive,reliable and non-invasive approach monitoring acute rejection after heart transplantation.It was especially suitable for monitoring anti-rejection therapy.Their combination was proved to be of great value in and screening of cardiac allograft rejection.It is the premise for perioperative and postoperative positive,rational anti-rejection therapy to reduce the acute rejection.