超声在脑-心双死亡器官捐献供肝体外膜肺氧合模式中的应用价值研究

朱贤胜; 程琦; 王莎莎; 叶创文; 庞树旺

doi:10.3969/j.issn.1674-7445.2016.02.008

超声在脑-心双死亡器官捐献供肝体外膜肺氧合模式中的应用价值研究

doi: 10.3969/j.issn.1674-7445.2016.02.008

510010 广州军区广州总医院超声科

详细信息

通讯作者:
朱贤胜, Email:zxsh873376@163.com

中图分类号: R617;R445.1
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出版历程
- 收稿日期: 2015-12-01
- 网络出版日期: 2021-01-19
- 刊出日期: 2016-03-15

Application of ultrasound in extracorporeal membrane oxygenation for the liver donation after brain-cardiac death

Department of Ultrasound, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, China

More Information

Corresponding author: Zhu Xiansheng, Email:zxsh873376@163.com

摘要

摘要: 目的评价超声在体外膜肺氧合(ECMO)保护脑-心双死亡器官捐献(DBCD)供肝中的应用价值。方法选取2006年4月至2014年11月广州军区广州总医院收治的符合供肝要求的40例脑死亡或不可逆脑损伤患者作为研究对象。分别在ECMO运转前、运转后5 min、停转即刻, 记录超声监测的供肝肝动脉流量(QHA)、门静脉流量(QPV)及ECMO导致的肝动脉ECMO流量(VE)。在相应时刻监测供体血液总胆红素(TB)、丙氨酸转氨酶(ALT)、乳酸的变化; 随访肝移植受者术后3个月内移植肝恢复情况。结果 ECMO转机时间平均为(1.0±0.2) h。使用ECMO运转前后QHA、QPV间差异均无统计学意义(均为P>0.05)。在使用ECMO运转前后肝功能指标比较差异均无统计学意义(均为P>0.05)。术后3个月内不同时间点对移植肝进行超声评估, 及对肝功能TB、ALT等进行检测, 结果显示40例受者移植肝功能均恢复良好。结论通过超声监测QHA, 选择最优ECMO流量灌注, 能保护DBCD供肝, 避免灌注损伤及灌注不足。
- 超声 /
- 体外膜肺氧合 /
- 供肝 /
- 脑-心双死亡器官捐献
Abstract: Objective To evaluate the application value of ultrasound in extracorporeal membrane oxygenation (ECMO) for protecting the liver donation after brain-cardiac death (DBCD). Methods Forty patients with brain death or irreversible brain injury, admitted to Guangzhou General Hospital of Guangzhou Military Command from April 2006 to November 2014, were eligible for liver donation. The hepatic artery blood flow (QHA), portal vein blood flow (QPV) and ECMO-induced ECMO flow of hepatic artery (VE) of the donor liver were monitored by ultrasound before, 5 min after the initiation of ECMO and immediately after ECMO. The changes of total bilirubin (TB), alanine transaminase (ALT) and lactic acid were observed at corresponding time points. Hepatic recovery was subsequently evaluated within 3 months after liver transplantation. Results The mean time of ECMO was (1.0±0.2) h. There was no significant difference in QHA and QPV before and after ECMO (both in P>0.05). And there was no significant difference in liver function parameters before and after ECMO (all in P>0.05). At different time points within postoperative 3 months, the results of ultrasound evaluation and liver function test revealed that the transplant liver function was well recovered in 40 recipients. Conclusions Through monitoring QHA by ultrasound, the best ECMO flow should be chosen, which protects DBCD liver and averts perfusion injury and hypoperfusion.
- Ultrasound /
- Extracorporeal membrane oxygenation /
- Donor liver /
- Donation after brain-cardiac death

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表 1 ECMO运转前后供肝血流量和ECMO流量指标变化

Table 1. The changes of blood flow volume of donor liver and ECMO flow before and after ECMO(x±s)

时间	n	QHA (ml/min)	QPV (ml/min)	VE (L/min)
运转前	40	206±32	451±65	-
运转后5 min	40	241±45	482±77	2.2±0.13
停转前即刻	40	220±50	451±59	2.3±0.31

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表 2 ECMO运转前后供肝肝功能指标的比较

Table 2. The comparison of targets of donor liver function before and after ECMO (x±s)

时间	n	TB (μmol/L)	ALT (U/L)	乳酸 (mmol/L)
运转前	40	18.8±5.9	82±47	5.3±3.6
运转后5 min	40	15.1±6.1	84±37	6.2±3.9
停转前即刻	40	15.3±4.1	69±45	7.3±4.8

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