CAJ | 학술논문

目的总结公民逝世后器官捐献供肺的评估及获取经验.方法回顾总结2007年11月至2013年12月19例潜在器官捐献者的资料.对所有供者进行了术前评估,均行痰培养、床旁支气管镜、胸部X线片及血液气体分析等检查.19例供者中,9例为心脏死亡器官捐献(DCD)供者,10例为脑死亡器官捐献(DBD)供者.经评估7例供肺无法利用,其中3例DCD和3例DBD供者因两肺广泛炎症浸润,氧合指数差未行供肺获取;1例DCD供者因心跳停止时间过长未行供肺获取;其余12例临床评估供肺良好.结果 12例供肺顺利获取,并转运至医院,共完成10例双肺移植和2例右侧单肺移植.12例受者手术顺利,术后早期因感染死亡2例,其余10例恢复顺利,肺功能得到极大改善,出院后接受长期随访,术后平均存活34.7个月(4～60个月).结论充分的供肺评估,随时保证供肺获取的应急状态,尽可能保存供肺肺功能是公民逝世后器官捐献供肺及肺移植成功的关键环节.
목적 총결공민서세후기관연헌공폐적평고급획취경험.방법 회고총결2007년11월지2013년12월19례잠재기관연헌자적자료.대소유공자진행료술전평고,균행담배양、상방지기관경、흉부X선편급혈액기체분석등검사.19례공자중,9례위심장사망기관연헌(DCD)공자,10례위뇌사망기관연헌(DBD)공자.경평고7례공폐무법이용,기중3례DCD화3례DBD공자인량폐엄범염증침윤,양합지수차미행공폐획취;1례DCD공자인심도정지시간과장미행공폐획취;기여12례림상평고공폐량호.결과 12례공폐순리획취,병전운지의원,공완성10례쌍폐이식화2례우측단폐이식.12례수자수술순리,술후조기인감염사망2례,기여10례회복순리,폐공능득도겁대개선,출원후접수장기수방,술후평균존활34.7개월(4～60개월).결론 충분적공폐평고,수시보증공폐획취적응급상태,진가능보존공폐폐공능시공민서세후기관연헌공폐급폐이식성공적관건배절.
Objective To summarize the experience of harvesting and using the lungs from donation after citizens death.Method From November 2007 to December 2013,19 cases of potential donation after brain death (DBD) and donation after cardiac death (DCD) were evaluated,including 9 cases of DCD and 10 cases of DBD.All the patients received the tests of sputum culture,bedside bronchoscopes,chest X rays,and blood gas analysis.After clear evaluation,3 cases of DCD and 3 cases of DBD were discharged from the group for bilateral inflammatory infiltration and poor oxygenation index,and the rest one case of DCD was precluded due to long warm ischemic time (＞60 min).The donor lungs from remaining 12 cases were harvested successfully after the declaration of brain death or cardiac death.The donors suitable for the transplant procedure were transported to our transplant center.Result Twelve lung transplants were performed successfully,including 10 cases of bilateral lung transplantation and 2 cases of right single lung transplantation.Two patients was complicated with severe infection and died of sepsis postoperatively,and the remaining 10 patients all recovered uneventfully with dramatic improvement of pulmonary function.During the follow-up period,all the patients lived an active life style with high quality of life.The mean survival time was 34.7 months (4-60 months).Conclusion Lung transplantation using DCD and DBD can be successfully performed after adequate preoperative evaluation of donor lung and abundant preparation for donor harvesting.