Abstract:

Objective To investigate the application of immunosuppresive protocol during perioperative period of heart transplantaion. Methods A total number of 25 patients accepted allogaft heart transplantation from March，2014 to December，2016. The immunosuppresive protocol included Basiliximab + Tacrolimus（Tac）+ Mycophenolate mofetil（MMF）. After operation the patients were followed-up and we observed complications，severe infection incidence，the rejection rate，etc. Results A total number of 25 patients recovered smoothly. Acute renal failure occurred in 3 cases，one patient was discharged from the hospital after dialysis，one patient died after intestinal obstruction，and one died of respiratory failure. there was no acute rejection reaction，and the mortality rate within one month was 0.04%，and the survival rate within 3 months was 88%，1 year survival rate was 84%，and the average of the last follow-up was（2.89±0.85）mg/d. Conclusion The immunosuppresive protocol based on tacrolimus can effectively prevent rejection after heart transplantation.

摘要：

目的 探讨以他克莫司为基础的免疫抑制治疗方案在心脏移植中的应用体会。方法 2014 年 3 月-2016 年 12 月在天津市第一中心医院对 25 例终末期心脏病患者施行同种异体心脏移植术，免疫抑制 方案为巴利昔单抗诱导，他克莫司、吗替麦考酚酯联合糖皮质激素的三联免疫抑制方案。术后监测他克莫 司谷值浓度、观察术后重症感染发生率，随访患者的心功能情况，排斥反应发生率等。结果 25 例心脏移 植患者移植手术顺利，均安返监护室，1 例患者术后 1 个月出现真菌感染，行肺叶切除术，术后恢复顺利， 1 例术后出现双侧膈神经麻痹经呼吸机治疗后 3 个月恢复出院，3 例术后出现急性肾功能衰竭，其中 1 例经 透析后出院，1 例出现肠梗阻后死亡，1 例出现呼吸循环衰竭死亡。术后早期无急性排斥反应发生，1 个月 以内病死率为 0.04%，3 个月内存活率为 88%，1 年存活率为 84%，末次随访平均他克莫司用量为（2.89± 0.85）mg / d。结论 采用以他克莫司为基础的免疫抑制剂方案可有效预防心脏移植术后排斥反应的发生。