本文選題：心臟移植　切入點：終末期心臟病　出處：《山東大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：總結(jié)分析原位心臟移植術(shù)治療終末期心臟病的方法、療效和經(jīng)驗。 方法：回顧性分析同種異體原位心臟移植40例受者的臨床資料。原發(fā)病包括擴張型心肌病29例、缺血性心肌病6例、肥厚型心肌病4例及限制性心肌病1例。手術(shù)方式采用標準法原位心臟移植術(shù)1例,雙腔靜脈吻合法原位心臟移植術(shù)39例。免疫抑制治療為環(huán)孢素、嗎替麥考酚酯、潑尼松的三聯(lián)用藥方案。其中5例受者未給予免疫誘導(dǎo)治療,6例受者術(shù)中給予抗Tac單克隆抗體誘導(dǎo)治療,29例受者于麻醉誘導(dǎo)及術(shù)后第4天給予巴利昔單克隆抗體的誘導(dǎo)治療。預(yù)防性抗菌素采用頭孢曲松鈉術(shù)前30分鐘及術(shù)后每日1次靜滴,術(shù)后根據(jù)痰培養(yǎng)及尿培養(yǎng)結(jié)果及時調(diào)整抗菌素方案。排斥反應(yīng)的監(jiān)測采用癥狀、心臟彩超、肌鈣蛋白、心肌酶譜的綜合評價。根據(jù)血藥谷濃度(CO)與峰濃度(C2)調(diào)整環(huán)孢素的血藥濃度至理想?yún)^(qū)間(CO理想?yún)^(qū)間150-200ng/mL和C2理想?yún)^(qū)間為800-1200ng/mL)。將患者基本信息及手術(shù)相關(guān)數(shù)據(jù)建立數(shù)據(jù)庫,采用SPSS18.0軟件包對數(shù)據(jù)進行綜合分析處理,各項數(shù)據(jù)用均數(shù)±標準差(x±s)表示,分析心臟移植術(shù)后療效。 結(jié)果：受者隨訪1-129個月,術(shù)后1月存活率95%(38/40)。1,3,5年生存率分別為90%,82.5%,77.5%。死亡原因包括：術(shù)后早期(術(shù)后1個月內(nèi))1例受者死于腸道出血,1例受者死于急性右心衰,術(shù)后晚期(術(shù)后1個月后)1例受者死于肺癌,1例受者死于真菌感染,4例受者死于移植物衰竭。共出現(xiàn)急性排斥反應(yīng)7例,包括術(shù)后早期急性排斥反應(yīng)2例,晚期5例,經(jīng)激素沖擊治療后均逆轉(zhuǎn),各排斥相關(guān)指標恢復(fù)正常,排斥反應(yīng)發(fā)生率17.5%。采用單純監(jiān)測血藥谷濃度時發(fā)生排斥反應(yīng)4例,發(fā)生率20%；采用環(huán)孢素血藥濃度谷、峰值同時監(jiān)測后發(fā)生排斥反應(yīng)3例,發(fā)生率15%。 結(jié)論：心臟移植術(shù)治療各類終末期心臟病療效確實可靠,可提高各類終末期心臟疾病患者的生存率和生活質(zhì)量。術(shù)后主要并發(fā)癥有：急性右心功能衰竭,急性排斥反應(yīng),感染。血藥濃度谷、峰值同時監(jiān)測可控制環(huán)孢素濃度在有效的范圍內(nèi),并可及時發(fā)現(xiàn)環(huán)孢素吸收的個體差異,給予及時調(diào)整環(huán)孢素用量,避免早期急性排斥反應(yīng)的發(fā)生。
[Abstract]:Objective: to summarize the methods, efficacy and experience of orthotopic heart transplantation in the treatment of end-stage heart disease. Methods: the clinical data of 40 patients with orthotopic heart transplantation were retrospectively analyzed. The primary diseases included dilated cardiomyopathy (29 cases) and ischemic cardiomyopathy (6 cases). There were 4 cases of hypertrophic cardiomyopathy and 1 case of restrictive cardiomyopathy. Standard method of orthotopic heart transplantation was used in 1 case and double vena cava anastomosis in 39 cases. Prednisone triplex regimen. Among them, 5 patients were not treated with immune induction. 6 recipients were treated with anti Tac monoclonal antibody induction during operation. 29 recipients were given baliximab monoclonal antibody during anesthesia induction and 4 days after operation. Prophylaxis of ceftriaxone sodium 30 minutes before operation and once a day after operation, The antibiotic regimen was adjusted according to the results of sputum culture and urine culture. The rejection was monitored by symptoms, color Doppler echocardiography, cardiac troponin. Comprehensive evaluation of myocardial zymogram. According to the concentration of ciclosporin (CO) and peak concentration (C2), the serum concentration of cyclosporine was adjusted to the ideal range of 150-200ng / mL CO and 800-1200ng / mL C2. The basic information of patients and the relevant data of operation were established. The data were analyzed by SPSS18.0 software package. The data were expressed as mean 鹵standard deviation (x 鹵s). Results: the recipients were followed up for 1-129 months, the survival rate was 95 / 38 / 40 / 1 on January, and the 5-year survival rate was 90 / 82.5 / 77.5 respectively. The causes of death included: early postoperative (1 patient died of intestinal bleeding within 1 month after operation) and 1 patient died of acute right heart failure (right heart failure). 1 case died of lung cancer and 1 case died of fungal infection 4 cases died of graft failure. Acute rejection occurred in 7 cases, including early acute rejection in 2 cases and late stage in 5 cases. After hormone shock treatment, all of them were reversed, the rejection indexes returned to normal, the incidence of rejection was 17.5%. 4 cases (20%) were treated with simple monitoring of blood drug concentration, and 20 cases with cyclosporine concentration valley. Rejection occurred in 3 cases after simultaneous monitoring of peak value, and the incidence was 15%. Conclusion: heart transplantation is effective and reliable in the treatment of various end-stage heart diseases, which can improve the survival rate and quality of life of patients with various end-stage heart diseases. The main postoperative complications are acute right heart failure and acute rejection. The peak concentration of cyclosporine can control the concentration of cyclosporine within the effective range, and the individual difference of the absorption of cyclosporine can be found in time, and the dosage of cyclosporine can be adjusted in time to avoid the occurrence of early acute rejection.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R654.2

【參考文獻】

相關(guān)期刊論文 前7條

1 王東,王春祥;同種異體原位心臟移植術(shù)(附1例報告)[J];山東醫(yī)藥;2004年02期

2 劉天起;王明華;王東;李培杰;李軍;馬延平;劉魯祁;許莉;李敏;張輝;;同種異體原位心臟移植(附11例報告)[J];山東醫(yī)藥;2007年09期

3 張世澤;周思伯;方立德;呂麗娟;王相才;翁是偉;陳忠元;龔蘭生;楊琪;丁懷翌;何冠雄;鄭魁元;洪鶴群;傅培彬;董方中;;原位心臟移植一例報告[J];上海醫(yī)學(xué);1978年10期

4 劉平;胡盛壽;杜娟;;心臟移植術(shù)后早期靜脈注射依諾前列環(huán)素(Iloprost)對血流動力學(xué)的影響[J];中國循環(huán)雜志;2006年03期

5 陳良萬,吳錫階 ,陳道中;原位心臟移植43例[J];中華醫(yī)學(xué)雜志;2004年08期

6 楊守國;王春生;陳昊;洪濤;胡克儉;莊亞敏;林熠;楊兆華;;298例原位心臟移植受者遠期療效分析[J];中華移植雜志(電子版);2011年02期

7 劉天起;王東;李培杰;李敏;馬延平;王明華;李軍;許莉;厲泉;張輝;路平;;原位心臟移植治療終末期心臟病25例臨床分析[J];中華移植雜志(電子版);2013年01期

，

本文編號：1561452