您的位置:山东大学 -> 科技期刊社 -> 《山东大学学报(医学版)》

山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (8): 86-91.doi: 10.6040/j.issn.1671-7554.0.2021.0619

• • 上一篇    下一篇

110例原位心脏移植临床经验

邹俊逸1,张辉2,张歆杰2,李子佳2,许明雷3,王东2   

  • 出版日期:2021-08-10 发布日期:2021-09-16
  • 通讯作者: 王东. E-mail:wangdong9859@sina.com
  • 基金资助:
    山东省自然科学基金(ZR2011HL013);山东省科技发展计划(2014GSF118090)

Clinical experience of 110 cases of orthotopic heart transplantation

ZOU Junyi1, ZHANG Hui2, ZHANG Xinjie2, LI Zijia2, XU Minglei3, WANG Dong2   

  1. 1. Clinical Medical College, Weifang Medical University, Weifang 261053, Shandong, China;
    2. Department of Cardiology Surgery, Shandong Provincial Heart Transplantation Center, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong, China;
    3. Shengli Oilfield Central Hospital Affiliated to Binzhou Medical University, Dongying 257000, Shandong, China
  • Online:2021-08-10 Published:2021-09-16

摘要: 目的 总结110例原位心脏移植治疗终末期心脏病患者临床经验及治疗效果。 方法 回顾性分析山东省千佛山医院心脏外科(山东省心脏移植中心)2003年3月至2020年7月完成的110例原位心脏移植供者及受者资料,从围手术期处理、免疫抑制的维持、感染监测、术后并发症的治疗以及随访指导等方面进行总结。 结果 手术成功率94.5%,术后并发症主要有右心功能不全(8.18%)、器官功能衰竭(15.76%)、急性排异反应(10.91%)、肺部感染(42.31%)及糖尿病(8.18%),均采用不同治疗方法取得满意效果。术后中位随访时间37个月(1~208个月),1、3、5年生存率分别为95.5%、84.2%、70.3%,其中9例存活超过10年。 结论 心脏移植是治疗终末期心脏病的最有效方法。手术治疗是成功的关键,通过采取术前评估供、受体质量匹配以及肝肾功能,术后给予个体化抗排异治疗,及时监测抗排异药物浓度,尤其是围手术期采用药物治疗、呼吸机支持、机械循环辅助装置以及持续肾脏替代和血浆置换等的综合治疗方法,可取得满意的近期和远期临床效果。

关键词: 心脏移植, 术后并发症, 免疫抑制治疗, 体外膜肺氧合, 主动脉内球囊反搏

Abstract: Objective To summarize the clinical experience of orthotopic heart transplantation in 110 cases. Methods Clinical data of 110 cases of heart transplantation in Shandong Provincial Heart Transplantation Center during the past 17 years were retrospectively reviewed. The perioperative management, maintenance of immunosuppression, infection monitoring, management of postoperative complications and follow-up guidance were summarized. Results The success rate of operation was 94.5%. The main postoperative complications were right heart insufficiency(8.18%), organ failure(15.76%), acute rejection(10.91%), lung infection(42.31%)and diabetes(8.18%). Different treatment methods were used and satisfactory results were achieved. During the median postoperative follow-up of 37(1-208)months, the 1-year, 3-year and 5-year survival rates were 95.5%, 84.2% and 70.3%, respectively, and 9 cases survived for more than 10 years. Conclusion Heart transplantation is the most effective treatment for end-stage heart diseases. The key is the success of surgery. Before surgery, we evaluated donor and recipient conditions, matched recipient quality, and tested liver and kidney functions. After surgery, we timely individualized anti-rejection treatment and monitored drug concentration, especially used drug therapy, ventilator, mechanical circulation, continuous renal replacement and plasma exchange, and achieved satisfactory short-term and long-term results.

Key words: Heart transplant, Postoperative complications, Immunosuppressive therapy, Extracorporeal membrane oxygenation, Intraaortic balloon counterpulsation

中图分类号: 

  • R654
[1] 刘天起, 王东, 李培杰, 等. 原位心脏移植治疗终末期心脏病25例临床分析[J]. 中华移植杂志(电子版), 2013, 7(1): 10-13. LIU Tianqi, WANG Dong, LI Peijie, et al. Analysis on 25 cases of orthotopic cardiac transplantation for end-stage heart disease[J]. Chinese Journal of Transplantation(Electron Version), 2013, 7(1): 10-13.
[2] 王东, 王春祥. 同种异体原位心脏移植术(附1例报告)[J]. 山东医药, 2004, 44(2): 28-30.
[3] 刘季春, 徐建军, 万于华, 等. 原位心脏移植的临床研究[J]. 江西医学院学报, 2006, 46(2): 59-61. LIU Jichun, XU Jianjun, WAN Yuhua, et al. Clinic study of 3 successful orthotopic heart transplantations [J]. Acta Academiae Medicinae Jiangxi, 2006, 46(2): 59-61.
[4] 王春生, 陈昊, 洪涛, 等. 原位心脏移植的手术体会[J]. 中华胸心血管外科杂志, 2002, 18(5): 274-277. WANG Chunsheng, CHEN Hao, HONG Tao, et al. Operative experience of orthotopic heart transplantation [J]. Chinese Journal of Thoracic And Cardiovascular Surgery, 2002, 18(5): 274-277.
[5] Goldraich LA, Leitão SAT, Scolari FL, et al. A comprehensive and contemporary review on immunosuppression therapy for heart transplantation [J]. Curr Pharm Des, 2020, 26(28): 3351-3384.
[6] Ram E, Klempfner R, Peled A, et al. Weight gain post-heart transplantation is associated with an increased risk for allograft vasculopathy and rejection [J]. Clin Transplant, 2021, 35(3): e14187. doi:10.1111/ctr.14187.
[7] 刘天起, 王东, 厉泉, 等. 原位心脏移植63例临床经验[J]. 中华移植杂志(电子版), 2017, 11(1): 19-23. LIU Tianqi, WANG Dong, LI Quan, et al. Clinical experience of 63 cases orthotopic heart transplantation [J]. Chinese Journal of Transplantation(Electron Version), 2017, 11(1): 19-23.
[8] Khush KK, Cherikh WS, Chambers DC, et al. The international thoracic organ transplant registry of the international society for heart and lung transplantation: thirty-sixth adult heart transplantation report-2019; focus theme: donor and recipient size match [J]. Heart Lung Transplant, 2019, 38(10): 1056-1066.
[9] Blackbourne LH, Tribble CG, Langenburg SE, et al. Successful use of undersized donors for orthotopic heart transplantation-with a caveat [J]. Ann Thorac Surg, 1994, 57(6): 1472-1476.
[10] 黄洁. 国人心脏移植注册数据分析与脑死亡心脏供体的选择和维护[J]. 实用器官移植电子杂志, 2016, 4(5): 295.
[11] Wang D, Zhang X, Li D, et al. Kaempferide protects against myocardial ischemia/reperfusion injury through activation of the PI3K/Akt/GSK-3β pathway [J]. Mediators Inflamm, 2017, 2017: 5278218.
[12] Hernandez GA, Lemor A, Clark D, et al. Heart transplantation and in-hospital outcomes in adult congenital heart disease patients with Fontan: a decade nationwide analysis from 2004 to 2014 [J]. J Card Surg, 2020, 35(3): 603-608.
[13] 刘永锋. 心脏死亡供者器官移植现状及展望[J]. 中华普通外科杂志, 2013, 28(3): 169-172.
[14] Taghavi S, Zuckermann A, Ankersmit J, et al. Extracorporeal membrane oxygenation is superior to right ventricular assist device for acute right ventricular failure after heart transplantation [J]. Ann Thorac Surg, 2004, 78(5): 1644-1649.
[15] Eckman PM, Katz JN, El Banayosy A, et al. Veno-arterial extracorporeal membrane oxygenation for cardiogenic shock: an introduction for the busy clinician [J]. Circulation, 2019, 140(24): 2019-2037.
[16] Nguyen VP, Kobashigawa JA. Antibody-medicated rejection after heart transplantation: diagnosis and clinical implications [J]. Curr Opin Organ Transplant, 2020, 25(3): 248-254.
[17] Rose AG. Understanding the pathogenesis and the pathology of hyperacute cardiac rejection [J]. Cardiovasc Pathol, 2002, 11(3): 171-176.
[18] Vega E, Schroder J, Nicoara A. Postoperative management of heart transplantation patients [J]. Best Pract Res Clin Anaesthesiol, 2017, 31(2): 201-213.
[19] Koo J, Wang HL. Acute, chronic, and humoral rejection: pathologic features under current immunosuppressive regimes [J]. Surg Pathol Clin, 2018, 11(2): 431-452.
[20] Lund LH, Edwards LB, Kucheryavaya AY, et al. The registry of the international society for heart and lung transplantation: thirtieth official adult heart transplant report - 2013; focus theme: age [J]. Heart Lung Transplant, 2013, 32(10): 951-964.
[21] 解衍博, 侯剑峰, 刘盛, 等. 体外膜氧合机械辅助在心脏移植手术中的应用[J]. 中华器官移植杂志, 2021, 42(2): 100-103. XIE Yanbo, HOU Jianfeng, LIU Sheng, et al. Application of mechanical assisted extracorporeal membrane oxygenation during heart transplantation [J]. Chinese Journal of Organ Transplantation, 2021, 42(2): 100-103.
[22] Fernández-Ugidos P, Barge-Caballero E, Gómez-López R, et al. In-hospital postoperative infection after heart transplantation: risk factors and development of a novel predictive score [J]. Transpl Infect Dis, 2019, 21(4): e13104.
[23] Bhagra SK, Pettit S, Parameshwar J. Cardiac transplantation: indications, eligibility and current outcomes [J]. Heart, 2019, 105(3): 252-260.
[24] Quader M, Toldo S, Chen Q, et al. Heart transplantation from donation after circulatory death donors: Present and future [J]. J Card Surg, 2020, 35(4): 875-885.
[25] Rajab TK, Jaggers J, Campbell DN. Heart transplantation following donation after cardiac death: history, current techniques, and future [J]. J Thorac Cardiovasc Surg, 2021, 161(4): 1335-1340.
[1] 胡连龙,宋光民,赵鑫,白霄,张健,赵廷蕾,王龙. CCL25/CCR9在大鼠心脏移植慢性排斥反应中的表达及意义[J]. 山东大学学报(医学版), 2016, 54(2): 1-5.
[2] 陈春艳,刘小军,祁绍艳,王文涛. 体外膜肺氧合在重症患者中的应用36例回顾分析[J]. 山东大学学报(医学版), 2016, 54(11): 40-43.
[3] 王砚池, 刘天起, 王东, 厉泉, 李培杰, 毕严斌, 李敏, 许莉, 马延平, 王明华. 同种异体原位心脏移植受者疗效分析[J]. 山东大学学报(医学版), 2014, 52(12): 60-63.
[4] 刘怡. 替罗非班联合IABP对冠脉复杂病变患者PCI术后的近期疗效观察[J]. 山东大学学报(医学版), 2014, 52(11): 45-48.
[5] 胡亮, 易永祥, 丁海, 韩建波, 刘涛,赵亮. 肝癌切除同时行脾切除加断流术术后并发症的相关因素分析[J]. 山东大学学报(医学版), 2013, 51(1): 64-66.
[6] . 心肌内心电图监测大鼠心脏移植术后急性排斥反应的实验研究[J]. 山东大学学报(医学版), 2009, 47(10): 32-34.
[7] 袭洁,吴树明,庞昕焱,张希全. 围术期主动脉内球囊反搏在危重
冠心病患者中的应用
[J]. 山东大学学报(医学版), 2009, 47(01): 82-84.
[8] 赵 鑫,徐巨林,宋光民,王绪健,宋惠民. VCAM-1在大鼠心脏移植慢性排斥模型中的表达[J]. 山东大学学报(医学版), 2007, 45(2): 127-129.
[9] 李跃华,宋惠民,庞昕焱,巩性军. 树突状细胞单克隆抗体对大鼠心脏移植排斥反应的免疫抑制作用[J]. 山东大学学报(医学版), 2006, 44(9): 875-877.
[10] 王洪伟,刘双德,焉杰克,田川,徐东升. 41例再次肾移植的临床分析[J]. 山东大学学报(医学版), 2006, 44(7): 722-725.
[11] 高雪,蔡可丽,吴晓莉,杨雪丽,霍伟. 雷帕霉素抑制兔眼后发性白内障的实验研究[J]. 山东大学学报(医学版), 2006, 44(6): 634-637.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 索东阳,申飞,郭皓,刘力畅,杨惠敏,杨向东. Tim-3在药物性急性肾损伤动物模型中的表达及作用机制[J]. 山东大学学报 (医学版), 2020, 1(7): 1 -6 .
[2] 张宝文,雷香丽,李瑾娜,罗湘俊,邹容. miR-21-5p靶向调控TIMP3抑制2型糖尿病肾病小鼠肾脏系膜细胞增殖及细胞外基质堆积[J]. 山东大学学报 (医学版), 2020, 1(7): 7 -14 .
[3] 龙婷婷,谢明,周璐,朱俊德. Noggin蛋白对小鼠脑缺血再灌注损伤后学习和记忆能力与齿状回结构的影响[J]. 山东大学学报 (医学版), 2020, 1(7): 15 -23 .
[4] 付洁琦,张曼,张晓璐,李卉,陈红. Toll样受体4抑制过氧化物酶体增殖物激活受体γ加重血脂蓄积的分子机制[J]. 山东大学学报 (医学版), 2020, 1(7): 24 -31 .
[5] 马青源,蒲沛东,韩飞,王超,朱洲均,王维山,史晨辉. miR-27b-3p调控SMAD1对骨肉瘤细胞增殖、迁移和侵袭作用的影响[J]. 山东大学学报 (医学版), 2020, 1(7): 32 -37 .
[6] 李宁,李娟,谢艳,李培龙,王允山,杜鲁涛,王传新. 长链非编码RNA AL109955.1在80例结直肠癌组织中的表达及对细胞增殖与迁移侵袭的影响[J]. 山东大学学报 (医学版), 2020, 1(7): 38 -46 .
[7] 史爽,李娟,米琦,王允山,杜鲁涛,王传新. 胃癌miRNAs预后风险评分模型的构建与应用[J]. 山东大学学报 (医学版), 2020, 1(7): 47 -52 .
[8] 肖娟,肖强,丛伟,李婷,丁守銮,张媛,邵纯纯,吴梅,刘佳宁,贾红英. 两种甲状腺超声数据报告系统诊断效能的比较[J]. 山东大学学报 (医学版), 2020, 1(7): 53 -59 .
[9] 丁祥云,于清梅,张文芳,庄园,郝晶. 胰岛素样生长因子II在84例多囊卵巢综合征患者颗粒细胞中的表达和促排卵结局的相关性[J]. 山东大学学报 (医学版), 2020, 1(7): 60 -66 .
[10] 徐玉香,刘煜东,张蓬,段瑞生. 101例脑小血管病患者脑微出血危险因素的回顾性分析[J]. 山东大学学报 (医学版), 2020, 1(7): 67 -71 .