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1、原位心脏移植治疗终末期心脏病33例作者：易定华，俞世强，王红兵，刘维永，张近宝，刘金成，程亮，崔勤【摘要】目的分析总结同种异体原位心脏移植治疗终末期心脏病改善早期存活率的经验。方法2000年1月至XX年4月共开展33例原位心脏移植术，男性29例，女性4例，年龄13〜58岁，体重31〜86(土)kg。扩张性心肌病23例，冠心病5例，瓣膜病1例，先天性心脏病1例，克山病3例。其中1例曾行冠状动脉旁路移植术。伴肝肾功能不全6例，左心室射血分数〜(±)%o供心热缺血时间为2〜7min,冷缺血时间为85〜137
2、(112±16)min。33例患者全部进行标准Stanford原位心脏移植术，XX年以前17例于术后即开始应用免疫抑制剂，XX年后16例采用改良的免疫抑制剂应用方法，即于手术前后应用达利珠单抗，于手术后5〜6d才开始应用FK506,维持血浓度谷值为15ng/L。结果XX年前早期死亡3例，2例分别于术后14d和38d死于霉菌感染，1例于术后31d死于精神抑郁和多脏器衰竭。XX年后16例术后无手术并发症、排斥反应及死亡。1年存活率％。结论终末期心脏病行原位心脏移植的临床疗效良好，免疫抑制剂应用的改良方法可
3、减少手术后早期免疫抑制剂用量，减少感染机会,提高早期存活率。【关键词】心脏移植；免疫抑制剂；早期存活率CasesofOrthotopicCardiacTransplantationforEnd-StageHeartDiseasesAbstract:OBJECTIVETosummarizetheoutcomeandclinicalexperienceofransplantationforesetreatment.METHODerwentorthotopiccaonfromJanuary2000t29ma
4、lesand4femal,土)age,wEightrangefwerediagnosedasdi1in23(onealsoaccompeurysm),ischemicheularheartdiseasein1,Keshandiseasein3rgoneCABGoperationdliverandkidneydysorthotopiccardiactnd-stageheartdiseaS33patientswereundrdiactransplantatioMarchXX,includingageran
5、gefroml3to58(rom3lto86(土)kg,whoatedcardiomyopathyaniedascendaortaanartdiseasein5,valv,Onepatienthasundebefore.6patientshafunction.EFvaluewehearthotischemictinutesandcoldischem137minutes.Theoper1IwerestandardStanrefromto(±)%.Donormewerefrom2to7miictimewe
6、refrom85toativeproceduresofafordorthotopiccardiactransp1antations.17patientswhoundionbeforeXXrecEIvetherapyimmediatelyafteroperation.Whierwenttransplantatmodifiedimmunosupptheywereadministernti-CD25monoc1onalaftertransplantatitopatientsfrom5to6daysafter
7、operationntrationkeptaroundebeforeXX,therewerithanoperativewithpergillusinfectionfectionandonediedondmultipleorganfaiesdoneafterXX,nopoations,rejectionordthesurvivalrateafCONCLUSIONOrthotoptationwasprovedtoberwenttransplantatdimmunosuppressivelei6patien
8、tswhoundionafterXXreceivedressivetherapy,andedwithDac1izumab(aantibody)beforeandonandFK506wasgiven,withtheserumconce15ng/thel7casesdone3operativedeathswonepatientdiedofas,onediedoffungalinfmentaldepressionalure.Amongthel6casstope
