CAJ | 학술논문

目的总结体外膜肺氧合(ECMO)保护心死亡供肝的初步经验.方法回顾分析2009年7月至2011年5月期间广州军区总医院肝移植中心施行的17例心死亡肝移植供者临床资料,了解供者原发病和有关指标、供者捐献与获取流程、ECMO使用方法.结果 17例供者均先诊断脑死亡然后等待心脏停跳,属于脑心双死亡供者(DBCD).在心死亡过程全部应用了ECMO,ECMO时间51～380(平均187)min.所有供者均成功获取了供肝并用于受者.受者全组无手术死亡.术后肝功能恢复满意,未发生原发性移植肝无功能并发症.术后1个月内因肺部感染死亡1例,其余16例顺利康复出院并随访至今,随访最长时间为29个月.结论 DBCD是我国公民心死亡供体的特殊类型.ECMO可以控制DBCD热缺血损伤且没有伦理学争议,对我国公民心死亡器官捐献有着十分重要的作用.
목적 총결체외막폐양합(ECMO)보호심사망공간적초보경험.방법 회고분석2009년7월지2011년5월기간엄주군구총의원간이식중심시행적17례심사망간이식공자림상자료,료해공자원발병화유관지표、공자연헌여획취류정、ECMO사용방법.결과 17례공자균선진단뇌사망연후등대심장정도,속우뇌심쌍사망공자(DBCD).재심사망과정전부응용료ECMO,ECMO시간51～380(평균187)min.소유공자균성공획취료공간병용우수자.수자전조무수술사망.술후간공능회복만의,미발생원발성이식간무공능병발증.술후1개월내인폐부감염사망1례,기여16례순리강복출원병수방지금,수방최장시간위29개월.결론 DBCD시아국공민심사망공체적특수류형.ECMO가이공제DBCD열결혈손상차몰유윤리학쟁의,대아국공민심사망기관연헌유착십분중요적작용.
Objective To summarize the early clinical experience of the extracorporeal membrane oxygenation (ECMO) for protecting the liver donation after cardiac death (DCD).Methods Review and analysis the clinical data of 17 cases of liver transplantation with the donors from Chinese citizen after cardiac death from July 2009 to May 2011 in our liver transplantation center,and comprehend the primary diseases and the relevant index of the donors,the flow-sheet of donation and obtain of the organs from the donation after cardiac death,and the apply methods of extracorporeal membrane oxygenation during those processes.Results All 17 cases had been diagnosed as brain death before,and waited for cardiac death,so all were clearly the donation of brain death plus cardiac death(DBCD).During the processes waiting for cardiac death,extracorporeal membrane oxygenation were introducted in every case,and the using time were 51-380 (mean 187)min.The donation after brain death plus cardiac death (DBCD) were all harvested liver donors and were transplanted to 17 receivers respectively.In our center,there was no operational death in liver transplantation in this series.The post-operation liver function recovered satisfactory,without transplant liver non-function or recovering delay.One case died of the pulmonary infection one month later after operation,and the other 16 cases all survived and were followed up to now.The longest survival time was 29 months.Conclusion The donation after brain death plus cardiac death (DBCD) was the special donation type for citizen in China.The extracorporeal membrane oxygenation (ECMO) could well control the warm ischemia for protecting the liver donor just without ethics dispute.So,the using of the extracorporeal membrane oxygenation (ECMO) for the liver donation after cardiac death(DCD)of citizen in our China have very important contribution.