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|本期目录/Table of Contents|

扩张型心肌病并发痛风患者的心脏移植(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2004年第4期
页码:
356-358
栏目:
临床研究
出版日期:
2004-07-01

文章信息/Info

Title:
Cardiac transplantation in dilated cardiomyopathy patients complicated with gout
作者:
俞世强1; 周更须1; 程亮1; 蔡振杰1; 姬秋和2
第四军医大学西京医院:1.心脏外科，2.内分泌科，陕西西安71003
Author(s):
YU Shi-giang1; ZHOU Geng-xu1; CHENG Liang1; CAI Zhen-jie1; JI Qiu-he2
1.D epartmento fC ardiovascularS urgery，2.D epartmento fE ndocrine，XijingH ospital，Fourth Military Medical University, Xi'an，Shaanxi 710032,Chin
关键词:
痛风; 心胜移植
Keywords:
Gout; cardiactransplantatio
分类号:
R541.
DOI:
-
文献标识码:
A
摘要:
目的:报告1例并发痛风的扩张型心肌病的心脏移植手术和进行痛风患者心脏移植的文献回顾.方法:受体是扩张型心肌病并发痛风患者，供体是50岁急性脑死亡患者。手术采用中度低温全麻体外循环，采用标准原位心脏移植手术方法.免疫抑制方案手术后早期采用挠悉，普乐可复和强的松，2周后改为硫哇嗦吟，环胞素A和强的松.结果:供体心脏热缺血时间为2 min，冷缺血时间为130 min，升主动脉阻闭时间为75 min，开放升主动脉后心脏 自动复跳，循环平稳。应用呼吸机时间为18 h,患者在手术后10d出现一次急性痛风性关节炎发作，用万络治疗好转。患者于手术后18d由隔离病房回到普通病房，病情稳定，血尿酸浓度正常，无关节症状.结论:尽管痛风患者进行心脏移植有许多风险，手术后还涉及痛风控制药物和免疫抑制剂的相互作用，但是如果处理得当，还是能够取得良好的手术效果。
Abstract:
AIM:To report cardiac transplantation in adilated cardiomyopathy patient complicated with gout and to review the treatment of gout patients with cardiac transplantation. METHODS:The recipient was a patient with dilated cardiamyopathy complicated with gout,the donor was a 50-year-old patient who died of a severe brain injury. Orthotropic heart transplantation was performed under general anesthesia and middle hypothermia cardiopulmonary bypass. Triple immunosuppression was performed at early postoperation with mycophenolate mofetil (MMF) tacrolimus and prednisone，and then two weeks postoperation with Cyclosporine，Azathioprine and Prednisone. RESULTS:Ischemic time was 130 min and aortic clamping-time was 75 min，the heart beat recovered automatically and hemodynamic was stable when CPB was weaned. Ventilation support remained for 18 hours postoperation. Acute episodes of gout polyarthrities occurred at the 10th day after the operation and cured by wanluo，a non-steroid anti-inflammatory drug. The patient was transferred to the ward at the 18th day postoperation without pain. CONCLUSION:Though gout patients are at high risk when undergoing heart transplantation because of the interaction between immunosuppression drugs and anti-gout drugs，we can still get good result under close monitoring.

参考文献/References

[1] Wluka AE, Ryan PF, Miller AM, et al. Post-cardiac transplantation gout,incidence of therapeutic complications[ J].J Heart Lung Transplant,20 00,19(10):951一956.

[2] Perez-Ruiz F, Alonso-Ruiz A, Calabozo M, et al. Treatment of gout after transplantation[J] .Br J Rheumatol,1 996,35(12):1329.

[3] Rozenberg S, Roche B, Dorent R,et al. Urate-oxidase for the treatment of tophaceous gout in heart transplant recipients.A report of three cases[J].Rev Rhum Engl Ed,1995,62(5),392一 394 .

[4] Perez-Ruiz F, Alonso-Ruiz A, Calabozo M, et al. Treatment of gout after transplantation[J].Br J R heumatol,1998,37(5):580

备注/Memo

备注/Memo:
收稿日期：2004-2-27
更新日期/Last Update: 2004-07-01