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目的总结婴儿原位心脏移植术后早期免疫抑制剂应用的临床经验。方法为1例患难治性先天性心脏病的8个月龄婴儿施行原位心脏移植术,术后1个月内应用环孢素A(CsA)、霉酚酸酯(MMF)及泼尼松预防急性排斥反应,1个月后停用泼尼松,仅用CsA和MMF,原则为小剂量用药。术后监测血CsA浓度、白细胞数及T淋巴细胞亚群。定期行超声心动图、心电图及X线胸片检查,结合临床症状与体征综合判断是否发生排斥反应,同时观察药物的不良反应。结果受者顺利渡过围手术期,现已存活260 d,未发生急性排斥反应及感染。术后1个月内血CsA浓度谷值(C_0)维持在0.1664～0.2080μmol/L,2～3个月C_0维持在0.1248～0.1664μmol/L,4～6个月C_0维持在0.0832～0.1248μmol/L,7～10个月C_0维持在0.0666～0.0998μmol/L。未见药物不良反应。结论婴儿原位心脏移植术后早期免疫抑制剂应根据婴儿免疫反应的特点,以口服给药为主、小剂量、不过多干预为原则。
Objective To summarize the clinical experience of early immunosuppressive agents in infants after orthotopic heart transplantation. Methods One elective 8-month-old infants with refractory congenital heart disease underwent elective cardiac transplantation. CsA, MMF and prednisone were administered within 1 month after operation. To prevent acute rejection, prednisone should be discontinued after 1 month, only CsA and MMF should be used, and the principle should be small dose. Postoperative blood CsA concentration, white blood cell count and T lymphocyte subsets were measured. Regular echocardiography, ECG and X-ray examination, combined with clinical symptoms and signs to determine whether there is a comprehensive rejection, and observed the adverse drug reactions. Results Recipient smoothly through the perioperative period, has now survived 260 days, no acute rejection and infection. Within 1 month after operation, the blood CsA concentration was maintained at 0.1664 ~ 0.2080μmol / L, the C_0 maintained at 0.1248 ~ 0.1664μmol / L in 2 ~ 3 months, and the C_0 maintained at 0.0832 ~ 0.1248μmol at 4 ~ 6 months / L, 7 ~ 10 months C_0 maintained at 0.0666 ~ 0.0998μmol / L. No adverse drug reactions. Conclusion Early immunosuppressive agents after orthotopic heart transplantation should be based on the characteristics of the infant’s immune response, with oral administration, low dose, but more intervention.