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供体亚低温状态对公民逝世后器官捐献移植肾功能的影响

刘克普 张更 李智斌 阮东丽 高龙 王会龙 郑文峰 袁建林

刘克普, 张更, 李智斌, 等. 供体亚低温状态对公民逝世后器官捐献移植肾功能的影响[J]. 器官移植, 2017, 8(5): 376-380. doi: 10.3969/j.issn.1674-7445.2017.05.008
引用本文: 刘克普, 张更, 李智斌, 等. 供体亚低温状态对公民逝世后器官捐献移植肾功能的影响[J]. 器官移植, 2017, 8(5): 376-380. doi: 10.3969/j.issn.1674-7445.2017.05.008
Liu Kepu, Zhang Geng, Li Zhibin, et al. Effect of hypothermia status in donors on renal graft function after renal transplantation from donation after citizen's death[J]. ORGAN TRANSPLANTATION, 2017, 8(5): 376-380. doi: 10.3969/j.issn.1674-7445.2017.05.008
Citation: Liu Kepu, Zhang Geng, Li Zhibin, et al. Effect of hypothermia status in donors on renal graft function after renal transplantation from donation after citizen's death[J]. ORGAN TRANSPLANTATION, 2017, 8(5): 376-380. doi: 10.3969/j.issn.1674-7445.2017.05.008

供体亚低温状态对公民逝世后器官捐献移植肾功能的影响

doi: 10.3969/j.issn.1674-7445.2017.05.008
详细信息
    通讯作者:

    袁建林, Email:jianliny@fmmu.edu.cn

  • 中图分类号: R617;R339.6

Effect of hypothermia status in donors on renal graft function after renal transplantation from donation after citizen's death

More Information
    Corresponding author: Yuan Jianlin, Email: jianliny@fmmu.edu.cn
  • 摘要:   目的  探讨供体亚低温状态对公民逝世后器官捐献肾移植早期肾功能影响。  方法  将符合入选条件的36例公民逝世后器官捐献供体根据处理方式随机分为常温组(体温36.5~37.5℃,19例)和亚低温组(体温34.0~35.0℃,17例)。对应供体分组的肾移植受体包括常温组(38例)和亚低温组(34例)。比较两组供体、受体的围手术期情况和两组受体术后移植肾功能恢复情况,包括移植物功能延迟恢复(DGF)和原发性无功能(PNF)发生率。  结果  两组供体围手术期的尿量、血清肌酐(Scr)、收缩压、血氧饱和度、热缺血时间和冷缺血时间比较,均无统计学意义(均为P < 0.05)。两组受体的手术时间、术中平均血糖、术中平均动脉压比较,差异均无统计学意义(均为P < 0.05)。亚低温组和常温组受体术后DGF发生率分别为6%和24%,两组受体DGF发生率比较,差异有统计学意义(χ2=4.393,P=0.036)。亚低温组和常温组受体术后PNF发生率均为3%,两组受体PNF发生率比较,差异无统计学意义(χ2=0.000,P=1)。  结论  供体亚低温状态可以显著降低受体DGF的发生率,对PNF的发生率则无明显影响。

     

  • 表  1  两组供体围手术期情况比较

    Table  1.   Comparison of perioperative period conditions of donors between two groups(x±s)

    组别 n 尿量(mL/d) Scr(μmol/L) 收缩压(mmHg) 血氧饱和度 热缺血时间(min) 冷缺血时间(h)
    亚低温组 17 1 768±684 105±37 127±11 0.991±0.011 5.6±0.7 2.1±1.3
    常温组 19 1 952±600 105±36 124±11 0.993±0.011 5.6±0.7 2.0±1.2
    t   0.860 0 0.778 0.562 0.057 0.139
    P   0.107 0.250 0.442 0.578 0.955 0.890
    下载: 导出CSV

    表  2  两组受体围手术期情况比较

    Table  2.   Comparison of perioperative period conditions of recipients between the two groups(x±s)

    组别 n 手术时间(min) 术中平均血糖(mmol/L) 术中平均动脉压(mmHg)
    亚低温组 34 90±12 5.2±0.7 121±13
    常温组 38 89±12 5.1±0.7 121±13
    t 0.472 0.202 0.188
    P 0.638 0.840 0.851
    下载: 导出CSV
  • [1] 袁小鹏, 周健, 陈传宝, 等. 心脏死亡器官捐献肾移植101例分析[J/CD]. 中华移植杂志(电子版), 2014, 8(1): 4-8. DOI: 10.3969/cma.j.issn.1647-3903.2014.01.002.

    Yuan XP, Zhou J, Chen CB, et al. Kidney transplantation from donation after cardiac death:a report of 101 cases[J/CD]. Chin J Transplant (Electr Vers), 2014, 8(1):4-8. DOI:10.3969/cma.j.issn.1647-3903.2014.01.002.
    [2] 张劲松, 孙昊.对我国亚低温治疗现状的认识[J].实用医院临床杂志, 2012, 9(1):31-33. DOI: 10.3969/j.issn.1672-6170.2012.01.009.

    Zhang JS, Sun H. Review of mild hypothermia therapy in China[J]. Pract J Clin Med, 2012, 9(1):31-33. DOI: 10.3969/j.issn.1672-6170.2012.01.009.
    [3] Niemann CU, Feiner J, Swain S, et al. Therapeutic hypothermia in deceased organ donors and kidney-graft function[J]. N Engl J Med, 2015, 373(5):405-414. DOI: 10.1056/NEJMoa1501969.
    [4] 脑死亡判定标准(成人)征求意见稿[J]. 中华医学杂志, 2003, 83(3): 262.

    The draft of the judgement standard of brain death (for adult)[J]. Natl Med J China, 2003, 83(3):262.
    [5] 卫生部脑死亡判定标准起草小组.脑死亡判定标准(成人)(修订稿)[J].中国脑血管病杂志, 2009, 6(4):220-224. DOI: 10.3969/j.issn.1672-5921.2009.04.014.

    The drafting group for brain death criteria of Ministry of Health of the People's Republic of China. Judgement standard of brain death (for adult)(revised edition)[J]. Chin J Cerebrovasc Dis, 2009, 6(4):220-224. DOI: 10.3969/j.issn.1672-5921.2009.04.014.
    [6] 中华医学会器官移植学分会. 中国心脏死亡器官捐献工作指南(第2版)[J/CD]. 实用器官移植电子杂志, 2013, 1(1): 9-12.

    Branch of Organ Transplantation of Chinese Medical Association. Guide of donation after cardiac death in China(2nd ed)[J/CD]. Pract J Organ Transplant (Electr Vers), 2013, 1(1):9-12.
    [7] 熊天威, 唐月娥, 杨扬, 等.我国公民逝世后器官捐献现状及管理探讨[J].器官移植, 2015, 6(2):71-74. DOI: 10.3969/j.issn.1674-7445.2015.02.001.

    Xiong TW, Tang YE, Yang Y, et al. Current situation and administration investigation on donation after citizen's death in China[J].Organ Transplant, 2015, 6(2):71-74. DOI: 10.3969/j.issn.1674-7445.2015.02.001.
    [8] 薛武军.公民逝世后器官捐献供肾评估方法及改善的研究进展[J].器官移植, 2015, 6(3):131-133. DOI: 10.3969/j.issn.1674-7445.2015.03.001.

    Xue WJ. Research progress on the evaluation methods and improvement of the kidney form donation after citizen's death[J]. Organ Transplant, 2015, 6(3):131-133. DOI: 10.3969/j.issn.1674-7445.2015.03.001.
    [9] Decruyenaere P, Decruyenaere A, Peeters P, et al. A single-center comparison of 22 competing definitions of delayed graft function after kidney transplantation[J]. Ann Transplant, 2016, 21:152-159. doi: 10.12659/AOT.896117
    [10] Denecke C, Biebl M, Fritz J, et al. Reduction of cold ischemia time and anastomosis time correlates with lower delayed graft function rates following transplantation of marginal kidneys[J]. Ann Transplant, 2016, 21:246-255. doi: 10.12659/AOT.896672
    [11] Wadei HM, Heckman MG, Rawal B, et al. Comparison of kidney function between donation after cardiac death and donation after brain death kidney transplantation[J]. Transplantation, 2013, 96(3):274-281. DOI: 10.1097/TP.0b013e31829807d1.
    [12] 薛武军, 项和立, 丁晨光, 等.公民逝世后器官捐献供者评估标准的研究[J].现代泌尿外科杂志, 2016, 21(2):99-103. DOI:10.3969/j.issn.1009-8291.2016.02. 007.

    Xue WJ, Xiang HL, Ding CG, et al. Study on the assessment standard of organ quality of donors with donation after citizen's death[J]. J Mod Urol, 2016, 21(2):99-103. DOI: 10.3969/j.issn.1009-8291.2016.02.007.
    [13] Azzopardi D, Strohm B, Marlow N, et al. Effects of hypothermia for perinatal asphyxia on childhood outcomes[J]. N Engl J Med, 2014, 371(2):140-149. DOI: 10.1056/NEJMoa1315788.
    [14] van der Worp HB, Macleod MR, Bath PM, et al. EuroHYP-1:European multicenter, randomized, phase Ⅲ clinical trial of therapeutic hypothermia plus best medical treatment vs. best medical treatment alone for acute ischemic stroke[J]. Int J Stroke, 2014, 9(5):642-645. DOI: 10.1111/ijs.12294.
    [15] Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33℃ versus 36℃ after cardiac arrest[J]. N Engl J Med, 2013, 369(23):2197-2206. DOI: 10.1056/NEJMoa1310519.
    [16] Tissier R, Giraud S, Quellard N, et al. Kidney protection by hypothermic total liquid ventilation after cardiac arrest in rabbits[J]. Anesthesiology, 2014, 120(4):861-869. DOI: 10.1097/ALN.0000000000000048.
    [17] 张驌, 陈妍君, 王诚, 等. Lifeport与静态低温保存应用于器官捐献供肾保存效果的Meta分析[J].器官移植, 2016, 7(4):268-274. DOI:10.3969/j.issn.1674-7445. 2016.04.004.

    Zhang S, Chen YJ, Wang C, et al. Meta analysis of the effect of Lifeport and static cold storage on donor kidney[J].Organ Transplant, 2016, 7(4):268-274. DOI: 10.3969/j.issn.1674-7445.2016.04.004.
    [18] Lee JH, Hong SY, Oh CK, et al. Kidney transplantation from a donor following cardiac death supported with extracorporeal membrane oxygenation[J]. J Korean Med Sci, 2012, 27(2):115-119. DOI:10.3346/jkms. 2012.27.2.115.
    [19] Villa G, Katz N, Ronco C. Extracorporeal membrane oxygenation and the kidney[J]. Cardiorenal Med, 2015, 6(1):50-60. DOI: 10.1159/000439444.
    [20] Willicombe M, Rizzello A, Goodall D, et al. Risk factors and outcomes of delayed graft function in renal transplant recipients receiving a steroid sparing immunosuppression protocol[J]. World J Transplant, 2017, 7(1):34-42. DOI: 10.5500/wjt.v7.i1.34.
    [21] Cruzado JM, Manonelles A, Vila H, et al. Residual urinary volume is a risk factor for primary nonfunction in kidney transplantation[J]. Transpl Int, 2015, 28(11):1276-1282. DOI: 10.1111/tri.12625.
    [22] 李昆, 钱叶勇, 王振, 等.中国标准Ⅲ类心脏死亡供者肾移植21例临床分析[J].解放军医学院学报, 2015, 36(5):433-436, 440. DOI:10.3969/j.issn.2095-5227. 2015.05.007.

    Li K, Qian YY, Wang Z, et al. Renal transplantation from Chinese category Ⅲ cardiac death donors:a clinical analysis of 21 cases[J]. Acad J Chin Pla Med School, 2015, 36(5):433-436, 440. DOI: 10.3969/j.issn.2095-5227.2015.05.007.
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出版历程
  • 收稿日期:  2017-06-18
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2017-09-15

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