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目的:观察自体骨髓单个核细胞经皮冠状动脉移植治疗重症心力衰竭的效果,探讨其可行性、安全性和有效性。方法:选取2006-02/08承德北方医院收治的20例重症心力衰竭患者,男14例,女6例,平均年龄(54±13)岁,由家属签署手术同意书。①患者俯卧位局麻,双测髂后上嵴行多点穿刺,抽取骨髓血60～260mL,要求在60min内完成。将采集的骨髓血进行骨髓细胞分离、洗涤,用生理盐水稀释单个核细胞悬液至20～30mL。②用PTCA球囊以先后顺序放置在左前降支中段或右冠状动脉中段,以4～6个大气压扩张球囊临时阻断远端血流,从球囊导管尾端注入分离净化的骨髓单个核细胞,左冠状动脉注射总量2/3,右冠状动脉注射总量1/3。③分别于术后1,3个月进行随访,检测NYHA心功能分级与射血分数,以6min标准步行实验评估运动能力。结果:实验选取20例重症心力衰竭患者,3例于术前发生猝死而退出试验,最终17例成功进行自体骨髓细胞移植,均完成术后3个月随访。①自体骨髓单个核细胞移植过程中的不良反应:17例患者中,严重心律失常1例,急性左心室衰竭1例,心绞痛2例,头痛1例,术中呕吐2例,术后低热1例,穿刺点血肿1例。②自体骨髓单个核细胞移植后不同时间NYHA心功能分级的变化:与术前比较,自体骨髓单个核细胞移植术后1,3个月NYHA心功能分级均明显提高(t=9.294～10.102,P均<0.01)。③自体骨髓单个核细胞移植后不同时间心功能指标与运动能力的变化:与术前比较,自体骨髓单个核细胞移植术后1,3个月NYHA心功能分级、左心室射血分数、左心室舒张末期直径、6min行走距离均得到明显改善(t=3.034～5.064,P<0.05)。④NYHA心功能改善程度与其他心功能参数的相关性:细胞移植后3个月,NYHA心功能分级改善程度与左心室射血分数、左心室舒张末期直径呈明显正相关(r=0.461～0.494,P均<0.05)。结论:经皮冠状动脉移植自体骨髓单个核细胞,可明显改善重症心力衰竭患者心功能及运动能力,安全可行。
Objective: To observe the effect of autologous bone marrow mononuclear cells percutaneous transluminal coronary angioplasty in the treatment of severe heart failure and to explore its feasibility, safety and effectiveness. Methods: Twenty patients with severe heart failure admitted to Northern Hospital of Chengde from February 2006 to June 2008 were selected, including 14 males and 6 females, with an average age of (54 ± 13) years. Signals of consent were signed by family members. ① patients prone local anesthesia, double test after iliac crest line multi-puncture, bone marrow blood drawn 60 ~ 260mL, required within 60min to complete. Bone marrow cells were harvested bone marrow cells were isolated and washed, diluted with normal saline mononuclear cell suspension to 20 ~ 30mL. ② with PTCA balloon placed in the order of the middle of the left anterior descending artery or right coronary artery to 4 to 6 atm balloon dilatation temporarily blocking the distal blood flow from the end of the balloon catheter injection of purified bone marrow mononuclear Cells, left coronary total 2/3, right coronary total 1/3. ③ Follow-up was performed at 1 month and 3 months after operation respectively. NYHA functional class and ejection fraction were measured. The exercise ability was evaluated by 6-minute standard walking test. Results: Twenty patients with severe heart failure were selected in the experiment. Three patients died of sudden death before surgery. Finally, 17 patients were successfully treated with autologous bone marrow transplantation. All patients were followed up for 3 months. Adverse reactions in autologous bone marrow mononuclear cells transplantation: Among 17 patients, 1 was severe arrhythmia, 1 was acute left ventricular failure, 2 was angina, 1 was headache, 2 was intraoperative vomiting, 1 was postoperative fever Puncture point hematoma in 1 case. (2) Changes of NYHA functional class at different time after autologous bone marrow mononuclear cells transplantation: New York Heart Association (NYHA) cardiac function classification was significantly improved at 1 and 3 months after autologous bone marrow mononuclear cell transplantation compared with preoperative levels (t = 9.294-10.102, P All <0.01). (3) Changes of cardiac function and exercise capacity at different time points after autologous bone marrow mononuclear cell transplantation: Compared with the preoperative level, NYHA functional class, left ventricular ejection fraction, Diastolic diameter, 6min walking distance were significantly improved (t = 3.034 ~ 5.064, P <0.05). (4) Correlation between NYHA heart function improvement and other cardiac function parameters: At 3 months after transplantation, the improvement of NYHA functional class was positively correlated with left ventricular ejection fraction and left ventricular end diastolic diameter (r = 0.461-0.494, P <0.05). Conclusion: Percutaneous coronary artery transplantation of autologous bone marrow mononuclear cells can significantly improve cardiac function and exercise capacity in patients with severe heart failure, safe and feasible.