成功连续实施14例DBD心脏移植临床总结

发布时间：2018-03-17 08:28

本文选题：脑死亡器官捐献　切入点：心脏移植　出处：《山东大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：分析总结山东省心脏移植中心脑死亡器官捐献(donation after brain death, DBD)心脏移植的可行性、疗效和经验。研究方法：回顾性分析2014年8月至2016年3月,本中心连续实施的14例DBD心脏移植病例。对收集的供、受者临床资料及受者术后恢复情况进行汇总、分析。所有捐献器官的获取和移植过程均符合国家规定。结果：14例DBD供体(男／女=12：2,平均年龄33.7岁)主要死因为颅脑损伤(9/14例)、脑血管意外(2/14例)、缺氧(1/14例)、中枢肿瘤(1/14例)、腹部外伤(1/14例),其中边缘供心3例。14例DBD心脏移植受者(男／女=9：5,平均年龄52.8岁)主要诊断为心肌病(10/14例)、冠心病(3/14例)、瓣膜病(1/14例)。移植术后,除了痰或尿培养阳性事件外,1例受者移植后出现原发性移植物功能衰竭,给予“主动脉内球囊反搏联合体外膜肺氧合”机械辅助治疗,术后第二天出现迟发性心包填塞,二次开胸治疗痊愈,术后1个月行胸部CT检查发现Standford B型主动脉夹层,行主动脉腔内隔绝术治疗；1例发生气胸,立即行闭式胸腔引流；1例术后早期急性肾功能不全,行血液透析治疗三天,肾功能恢复正常；1例术前应用呼吸机辅助通气治疗患者,术后出现气管狭窄,两次于我院行纤支镜下肉芽组织电灼治疗,效果差,于外院行气管支架植入术。所有患者术后均根据原位杂交基因检测结果确定免疫抑制剂起始剂量及用药方案,通过监测血药浓度谷、峰值,调整用药剂量,无急性排斥反应发生。14例受者全部痊愈出院,现已恢复正常工作,生活质量良好,受者术后平均随访时间11.1个月(3-19个月),1个月及3个月生存率均为100%。结论：经严格筛选的DBD供心可用于心脏移植,且能取得良好的临床效果。DBD是解决我国当前心脏移植供心短缺的有效途径。术前及术后尽早积极地采用机械辅助支持,将有助于延长受体等待时间、促进移植者心功能恢复,大幅度改善患者预后。采用原位杂交基因检测等方法,有助于个体化用药,提高患者生存质量。
[Abstract]:Objective: to analyze the feasibility, curative effect and experience of brain death organ donation after brain death (DBD) in Shandong Heart Transplantation Center. Methods: from August 2014 to March 2016, a retrospective study was conducted. There were 14 consecutive cases of DBD heart transplantation performed in our center. The donors, the clinical data of the recipients and the postoperative recovery of the recipients were summarized. All donor organs were obtained and transplanted according to state regulations. Results: 14 DBD donors (male / female 12: 2, mean age 33.7 years) died mainly from craniocerebral injury in 9 / 14 cases, cerebrovascular accident in 2 / 14 cases, hypoxia in 1 / 14 cases, anoxia in 14 cases. There were 14 cases of armature tumor, 14 cases of abdominal trauma and 14 cases of abdominal trauma. Among them, 3 cases of marginal donor heart, 14 cases of DBD heart transplant recipients (male / female 9: 5, mean age 52.8 years) were mainly diagnosed as 10 / 14 cases of cardiomyopathy, 3 / 14 cases of coronary heart disease, 14 cases of valvular disease and 1 / 14 cases of valvular disease. In addition to sputum or urine culture positive events, one recipient developed primary graft failure after transplantation. He was treated with mechanical adjuvant therapy of "intraaortic balloon counterpulsation combined with external membrane pulmonary oxygenation", and delayed pericardial tamponade appeared on the second day after operation. The second thoracotomy was cured, the Standford B aortic dissection was found by CT examination 1 month after operation, the pneumothorax occurred in 1 case by endovascular exclusion of aorta, and the acute renal insufficiency was found in 1 case immediately by closed thoracic drainage. After three days of hemodialysis treatment, one patient with normal renal function was treated with ventilator assisted ventilation before operation. He developed trachea stenosis after operation, and was treated with cauterization of granulation tissue under fiberoptic bronchoscope, and the effect was not good. All patients were treated with tracheal stent implantation in our hospital. According to in situ hybridization gene test results, the initial dose of immunosuppressant and the drug regimen were determined, and the dosage was adjusted by monitoring blood concentration valley, peak value, and adjusting dosage. No acute rejection occurred. All of the 14 patients were cured and discharged from hospital, and now they have returned to normal work, and the quality of life is good. The mean follow-up time was 11.1 months to 19 months. The survival rate of 1 and 3 months was 100. Conclusion: DBD donor heart can be used for cardiac transplantation. DBD is an effective way to solve the shortage of donor heart in our country. Using mechanical support as early as possible before and after operation will help to prolong the waiting time of the recipient and promote the cardiac function recovery. The method of in situ hybridization gene detection is helpful for individualized drug use and the improvement of patients' quality of life.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R654.2

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