CAJ | 학술논문

目的总结体外膜肺氧合(ECMO)用于脑心双死亡供者(DBCD)器官获取的流程和方法.方法回顾分析2009年1月至2012年12月完成的39例DBCD器官捐赠.39例供者中,男性30例,女性9例,年龄(28.1±10.2)岁,体质量指数为(21.3±2.5)kg/m2；原发病为重型脑外伤29例,脑血管意外8例,以及缺血缺氧性脑病2例.评估供者危险指数为1.27±0.28.39例供者在捐赠器官过程中均使用了ECMO支持.结果 ECMO使用时间为(161±77)min.ECMO起始流量为(3.14±0.24) L/min,平衡流量为(1.76±0.58)L/min,复灌流量为(3.10±0.48) L/min.供者器官热缺血时间均为0 min.供者评估时、ECMO使用前、器官获取前供者胆红素总量、丙氨酸转氨酶均无显著性差异,但获取前血清肌酐水平显著升高,尿量显著减少.共获取38个肝脏,78个肾脏,分别实施了37例肝移植、64例肾移植.1个肝脏因合并乙型肝炎病毒表面抗原阳性未匹配到合适受者而未使用,14个肾脏因肾功能不全、肾结石未使用.结论供者家属和伦理委员会对使用ECMO没有争议,ECMO辅助DBCD器官获取可避免热缺血损伤,获得更满意的移植效果.
목적 총결체외막폐양합(ECMO)용우뇌심쌍사망공자(DBCD)기관획취적류정화방법.방법 회고분석2009년1월지2012년12월완성적39례DBCD기관연증.39례공자중,남성30례,녀성9례,년령(28.1±10.2)세,체질량지수위(21.3±2.5)kg/m2；원발병위중형뇌외상29례,뇌혈관의외8례,이급결혈결양성뇌병2례.평고공자위험지수위1.27±0.28.39례공자재연증기관과정중균사용료ECMO지지.결과 ECMO사용시간위(161±77)min.ECMO기시류량위(3.14±0.24) L/min,평형류량위(1.76±0.58)L/min,복관류량위(3.10±0.48) L/min.공자기관열결혈시간균위0 min.공자평고시、ECMO사용전、기관획취전공자담홍소총량、병안산전안매균무현저성차이,단획취전혈청기항수평현저승고,뇨량현저감소.공획취38개간장,78개신장,분별실시료37례간이식、64례신이식.1개간장인합병을형간염병독표면항원양성미필배도합괄수자이미사용,14개신장인신공능불전、신결석미사용.결론 공자가속화윤리위원회대사용ECMO몰유쟁의,ECMO보조DBCD기관획취가피면열결혈손상,획득경만의적이식효과.
Objective To summarize the procedure and method of extracorporeal membrane oxygenation (ECMO) support donation after brain death followed by cardiac death (DBCD).Method The clinical data,the selected standard and the organ procurement procedure of 39 DBCD cases were retrospectively analyzed from January 2009 to December 2012 in our liver transplantation center,including 30 males and 9 females with the mean age and mean BMI of 28.1 ± 10.2 and 21.3 ± 2.5 respectively.The primary diseases included head trauma (29 cases),intracranial bleeding (8 cases),and anoxia (2 cases).The mean DRI was 1.27 ± 0.28.ECMO was introduced in all the donors.Result The mean length of ECMO time was 161 77 min.The initial,balance and reperfusion value of ECMO volume was 3.14 ± 0.24,1.76 ± 0.58 and 3.10 ± 0.48 L/min respectively.All the donors had no warm ischemia time.The TBIL and ALT showed no significant difference in all the donors when estimated,before the ECMO started and before the organ procurement,but the Cr was increased and urine output decreased significantly.All the donated organs included 38 livers,and 78 kidneys.Thirty-seven cases of liver transplantation and 64 cases of kidney transplantation were performed finally.One liver out of the 38 cases was unused due to the positive HbsAg,and 14 kidneys unused due to renal insufficiency and kidney stones.Condusion There is no dispute in the ethics Committee and all the donor's family members about the usage of ECMO.The ECMO support DBCD could well control the warm ischemia,and obtain satisfactory curative effect of transplantation.