摘要
目的 针对2022年开展的基因编辑猪-恒河猴心脏异种移植实验,总结并分析围术期受体感染情况及治疗策略,为异种移植围术期感控提供指导.方法 以雄性基因编辑(GTKO/β4GalNT2 KO/CMAH KO/hCD55/hCD46/hTBM)猪为供体,以雄性恒河猴为受体,将猪心脏异位移植入恒河猴腹腔内.围术期给予重症监护,监测感染指标包括体征、血常规、血清炎性因子、胸片以及细菌培养(血液、引流液、分泌物、排泄物),并根据感染指标变化调整抗感染药物的使用.结果 受体恒河猴存活且移植心脏维持收缩功能20 d,体温及血常规波动较小,未见高热(＞38.5℃)和白细胞升高的情况,术后第9日胸片出现类似感染的斑片状阴影,调整抗生素使用和加强肺部护理后好转,术后炎性指标C-反应蛋白和降钙素原均未见明显升高,术后第13日口腔分泌物、腹水、胃液细菌培养溶血葡萄球菌阳性.结论 高强度、大剂量使用免疫抑制药物导致异种移植术后受体发生感染概率增加,通过及时的检查检验和治疗调整可以有效控制感染的进展.
Abstract
Objective To summarize and analyze the perioperative recipient infection and treatment strategies according to the gene-edited pig-to-rhesus heart xenotransplantation in 2022,so as to provide guidance for perioperative infection control of xenotransplantation.Methods The experiment utilized male gene-edited(GTKO/β4GalNT2 KO/CMAH KO/hCD55/hCD46/hTBM)pig as donor and male rhesus as recipient.Pig heart was ectopically transplanted into the abdominal cavities of the recipient.Perioperative intensive care was given to monitor infection indicators including signs,blood routine,serum inflammatory factors,chest radiographs,and bacterial cultures(blood,drainage,secretions,and excretions).The use of anti-infective drugs was adjusted based on changes in these indicators.Results The recipient rhesus survived and the transplanted heart maintained systolic function for 20 d,with minimal fluctuations in body temperature and blood routine,no hyperthermia(＞38.5 ℃)or elevated white blood cell counts.On the 9 th day after surgery,chest X-rays revealed patchy shadows resembling infection,which was improved after adjusting antibiotic usage and strengthening lung care.Postoperative inflammatory indicators,such as C-reactive protein and procalcitonin,did not show significant increases.However,on the 13th day after surgery,bacterial cultures from oral secretions,ascites,and gastric juice were positive for Staphylococcus haemolyticus.Conclusion The high-intensity and high-dose use of immunosuppressive drugs leads to an increased incidence of recipient infections following xenotransplantation.Nonetheless,the timely examination and adjustment of treatment strategies can effectively control the progression of these infections.
基金项目
国家自然科学基金面上项目(82370273)
空军军医大学西京医院临床新技术项目(XJSZ03)
空军军医大学西京医院临床新技术项目(XJSM02)
空军军医大学西京医院临床新技术项目(XJSM14)
空军军医大学西京医院临床新技术项目(XJSM15)
空军军医大学西京医院学科助推计划(XJZT23XG28)
国家科技期刊平台
NSTL
维普
万方数据