CAJ | 학술논문

目的总结3例心肺移植的经验.方法 2003年7月至2012年8月,3例终末期心肺疾病患者施行心肺移植手术.1例先天性房间隔缺损伴艾森曼格综合征,心功能Ⅳ级；1例扩张性心肌病伴中重度肺动脉高压,心功能Ⅲ～Ⅳ级；1例左心室双出口合并室间隔缺损伴肺动脉主干及左、右分支狭窄,心功能Ⅲ～Ⅳ级.心肌保护液均为UW液；肺保护液均加入前列腺素E1,Euro-Collin液1例,低钾右旋糖酐液2例.术前给予赛尼派或巴利昔单抗、术中甲基泼尼松龙、术后环孢素/他克莫司+泼尼松+骁悉抗排斥治疗.术中严密止血.移植术后严格消毒、隔离,加强呼吸道护理.例2患者术毕至术后31天胸液量14 640ml,术后40天内应用纤维支气管镜吸痰13次,同时使用广谱抗生素及抗真菌药物控制感染.结果 3例患者全部痊愈出院.1例术后4年10个月因慢性排异反应引起的阻塞性支气管炎、肺功能衰竭死亡；1例术后68天因突发脑血管意外死亡；1例目前健在,已生存1年余.结论妥善保护心肺功能,术中认真止血,手术操作精细,术后加强防治感染,重视应用纤维支气管镜和合理的抗排斥治疗是心肺移植成功的重要因素.
목적 총결3례심폐이식적경험.방법 2003년7월지2012년8월,3례종말기심폐질병환자시행심폐이식수술.1례선천성방간격결손반애삼만격종합정,심공능Ⅳ급；1례확장성심기병반중중도폐동맥고압,심공능Ⅲ～Ⅳ급；1례좌심실쌍출구합병실간격결손반폐동맥주간급좌、우분지협착,심공능Ⅲ～Ⅳ급.심기보호액균위UW액；폐보호액균가입전렬선소E1,Euro-Collin액1례,저갑우선당항액2례.술전급여새니파혹파리석단항、술중갑기발니송룡、술후배포소/타극막사+발니송+효실항배척치료.술중엄밀지혈.이식술후엄격소독、격리,가강호흡도호리.례2환자술필지술후31천흉액량14 640ml,술후40천내응용섬유지기관경흡담13차,동시사용엄보항생소급항진균약물공제감염.결과 3례환자전부전유출원.1례술후4년10개월인만성배이반응인기적조새성지기관염、폐공능쇠갈사망；1례술후68천인돌발뇌혈관의외사망；1례목전건재,이생존1년여.결론 타선보호심폐공능,술중인진지혈,수술조작정세,술후가강방치감염,중시응용섬유지기관경화합리적항배척치료시심폐이식성공적중요인소.
Objective To summarize the successful experience of three cases of heart-lung transplantations performed in our institute.Methods From July 2003 to August 2012,three patients,with diagnosis of end-stage heart-lung diseases,received heart-lung transplantation in our institute.One case was diagnosed as congenital atrial septal defect,Eisenmanger syndrome,NYHA class Ⅳ; one was dilated cardiomyopathy with moderate/severe pulmonary arterial hypertension,NYHA class Ⅲ-Ⅳ,one was diagnosed as double outlet left ventricle (DOLV) with ventricle septal defect and stenosis of pulmonary artery and its left and right branches,NYHA class Ⅲ-Ⅳ.Donor hearts were preserved with UW solution,donor lungs were preserved with Euro-Collin solution in case one and with low potassium dextran containing prostaglandin E1 in the others.Extensive disinfection and strict scrutiny were implemented postoperatively.Immunosuppressive therapy included administration of zenapax or basiliximab preoperatively,methylprednisolone during the operation,and cyclosporine a/tacrolimus + prednisone + mycophenolate postoperatively.Surgical hemostasis is of great importance,as the total pleural effusion reaches 14 640 ml within 31 days postoperatively in case two.Strict postoperative disinfection and isolation were implemented,and management of the respiratory tract was intensified.Therapeutic bronchoscopy was performed frequently for sputum suction.In case two,bronchoscopy was used thirteen times within 40 days after transplantation.Broad-spectrum antibiotics and antifungal antibiotics were used for infection control.Results All three patients were discharged after recovery from operation.Case one died of obstructive bronchitis and lung failure caused by chronic rejection four years and ten months postoperatively.Case two died of sudden cerebrovascular accident 68 days after operation.Case three survives more than one year postoperatively so far and is still alive.Conclusion Proper preservation of the donor heart and lung,perfect surgical hemostasis,strict infection control,frequent application of bronchoscopy and appropriate immunosuppressive management are critical to the success of heart-lung transplantation.