摘要
目的探讨体外膜肺氧合（ECMO）技术在公民逝世后器官捐献中对供者的维护及在器官获取中的作用。方法2013-2014年，对循环或呼吸功能衰竭的脑死亡器官捐献（DBD）供者（5例）及不可控性心脏死亡器官捐献（DCD）供者（1例）进行研究，根据ECMO介入指征，使用ECMO对供者进行循环及呼吸支持。采用经皮肝脏穿刺活组织快速冰冻切片，判断肝脏脂肪变性及纤维化程度。记录ECMO介入指征、ECMO转流相关参数及血液气体分析结果。检测ECMO介入前后的丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、肌酐水平，评价肝、肾功能及损伤情况，判断肝、肾是否符合器官移植要求。结果6例供者均应用ECMO，其中5例DBD供者因呼吸或循环功能衰竭采用静脉一动脉（V-A）ECMO进行辅助，1例不可控性DCD采用胸主动脉封闭的、V-A ECMO恢复再循环。4例供者的4个肝脏和8个肾脏获取后用于移植，2例供者器官因损伤超出标准被弃用。结论对于循环、呼吸功能衰竭的DBD供者及不可控性DCD供者，使用ECMO辅助循环和呼吸功能以及恢复DCD再循环，可避免大量血管活性药物的应用及减轻DCD热缺血导致的肝、肾功能损伤，减少公民逝世后器官捐献中器官弃用的发生。
Objective To study the effect of extracorporeal membrane oxygenation （ECMO） in donor preservation and organ procurement of donation after citizens＇ death. Method From 2013 to 2014, according to the ECMO indications, we used ECMO to provide circulation and breathing support for circulatory or respiratory function failure donation after brain death（DBD） donor and uncontrolled donation after cardiac death （DCD） donors. Through percutaneous liver puncture and living tissue rapid frozen section, the liver steatosis and fibrosis degree was determined. ECMO indications, ECMO related parameters and the result of blood gas analysis were recorded, alanine aminotransferase（ALT）, aspartate aminotransferase（AST） and creatinine（Cr） before and after ECMO intervention were detected to evaluate liver and kidney function and damage. Whether the liver and kidney reached the requirements of the organ transplantation was assessed. Result The ECMO was used in 6 donors. Five cases of DBD were assisted through V-A ECMO because of circulatory or respiratory function failure. In one case of uncontrolled DCD recirculation was established through the thoracic aorta-blocked V-A ECMO. Four livers and 8 kidneys, from 4 donors, were retrieved and transplanted. Two donors＇ organs were discarded for damage beyond the standard. Conclusion For DBD donor with circulatory or respiratory function failure and uncontrolled DCD donors, the use of ECMO to assist circulatory and respiratory function or establish DCD recirculation can avoid liver and kidney injuries from vascular active drugs and DCD warm ischemia injury, thus, reduce the organ discarding rate of donation after citizens＇ death.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2014年第9期537-541,共5页
Chinese Journal of Organ Transplantation
基金
湖北省自然科学基金（2013CFB258）
武汉市科学技术计划项目（2013060705010326）
关键词
供者
器官捐献
体外膜氧合作用
器官获得
脑死亡
Donors
Organ donation
Extracorporeal membrane oxygenation
Organ procurement
Brain death
