目的:观察经皮经腔冠状动脉内移植自体骨髓单个核细胞( bone marrow mononuclear cells,BMMNCs) 治疗心力衰竭(congestive heart failure,CHF)的可行性与临床疗效。方法:选取自2007-11 ~2010-05 在我 科住院的常规心力衰竭药物治疗无明显改善的CHF 病人共30 例,其中4 例病人接受并同意BM-MNCs 治疗,其 余病人继续常规治疗,并形成对照组。治疗组完善术前准备后,在无菌条件下行骨穿,抽取骨髓夜50mL,将骨髓 液试剂处理后分离获得自体骨髓单个核细胞,经皮经导管由冠状动脉注入血管远端。实验组所有病人均术前及 术后3、6、12、24 mo 顺利完成随访,对照组相应完成随访内容并继续常规药物治疗。结果:治疗组病人随访显示 移植前后左室射血分数(LVEF)、室壁运动积分指数(WISM)、6 min-walk、BNP 均明显改善,PET-CT 提示缺损心 肌有所恢复,没有1 例病人因心衰加重住院,随访期内病人未发生心律失常,无心源性猝死,与对照组相比也具 有统计学意义。结论:经皮经腔冠状动脉内移植BM-MNCs 治疗充血性心力衰竭安全可行,能显著改善左室射 血分数。但由于本实验例数较少,尚有一定的局限性。

Objective: This study evaluated the hypothesis that intracoronory infusion of boneintestinal effects (nausea、vomit、coprostatis),deteriorated of angina or heart failure and some rare effects ( spontaneous spleen rupture, severe purulent infection, hypercoagulable state, autol ogous immune diseases). When the circulating blood stem was separated and collected,the complications also need be paid attention to,for example,low calcium effects(anaesthesia of mouth and lip,muscle spasm),pale and dizziness due to vagus reflect, pale and dizziness owing to low blood volume, deterioration of angina or heart failure. The complications also should be observed during the circulating blood stem cell transplantation by intracoronary infusion, which were arrhythmia including of bradycardia,sinus arrest or atrial ventricular block,ventricular fibrillation;hypotention,etc. Baseline e鄄 valuations included complete clinical and laboratory evaluations,and 2 D Doppler echocardiogram. Treated patients underwent 3、6-month noninvasive follow-up according to standard protocols and with the same procedures used as at baseline. Results:There were total 11 cases with complications during the mobilization,separating,collection,and infusion of circulating blood stem cell. The incidence of complications during mobilization was 28. 5% (4/14),eg,bone pain was 21. 4% (3/14),fever was 7. 1% (1/14);during separating and collecting was 28. 5%(4/14),eg,low calcium effectswas 21. 4% (3/14),deterioration of angina or heart failurewas 7. 1% (1/14);and during the circulating blood stem cell transplantation by intracoronary infusion,was 21. 4% (3/14),eg,ventricular premature was 14. 1%(2/14),hypotention was 7. 1%(1/14). After 3 and 6 month,there was a significant improved in global left ventricular functionwithin the treated patients,ejection fraction from a baseline of 39% to 50%、54%,(P =0. 011、0. 043),WISM from 1. 15 to 1. 14、1. 25(P =0. 554、0. 573),and left enddiastolic volume(LVDD)from 56. 80 mm、54. 33 mm,58. 50 mm(P = 0. 662,0. 833). No death was observed. Conclusions:Thus,the present study demonstrates that the relative safety of intracoronary infusion of PBSCs in patients with CHF and the potential for improving global left ventricular function. marrow mononuclear Cells in patients with CHF could safely improve myocardial function. Methods:4 with AMI were allocated to receive Granulocyte Colony-Stimulating Factor (G-CSF) with the dose of 300滋g-600滋g/ d tomobilize the stem cell,and the duration of applyingG-CSFwas 5 days. On the sixth day,PBSCwas separated by Baxter CS 3000 blood cell separator into stem cell suspend liquid 50mL. Then the suspend liquid was infused into the stenosis artery by occluding the over the wire balloon and infusing artery through balloon center lumen. In the process of the mobilization of the circulating blood stem cell,the following side effects should be paid attention to,such as:bone pain,tetter,fever,gastro鄄

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