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ECMO技术在公民逝世后器官捐献供肝保护中的临床应用

丁利民 李新长 徐志丹 杨小刚 黄小梅 罗文峰

丁利民, 李新长, 徐志丹, 等. ECMO技术在公民逝世后器官捐献供肝保护中的临床应用[J]. 器官移植, 2019, 10(5): 594-598. doi: 10.3969/j.issn.1674-7445.2019.05.021
引用本文: 丁利民, 李新长, 徐志丹, 等. ECMO技术在公民逝世后器官捐献供肝保护中的临床应用[J]. 器官移植, 2019, 10(5): 594-598. doi: 10.3969/j.issn.1674-7445.2019.05.021
Ding Limin, Li Xinchang, Xu Zhidan, et al. Clinical application of ECMO in protecting donor liver in organ donation after citizen's death[J]. ORGAN TRANSPLANTATION, 2019, 10(5): 594-598. doi: 10.3969/j.issn.1674-7445.2019.05.021
Citation: Ding Limin, Li Xinchang, Xu Zhidan, et al. Clinical application of ECMO in protecting donor liver in organ donation after citizen's death[J]. ORGAN TRANSPLANTATION, 2019, 10(5): 594-598. doi: 10.3969/j.issn.1674-7445.2019.05.021

ECMO技术在公民逝世后器官捐献供肝保护中的临床应用

doi: 10.3969/j.issn.1674-7445.2019.05.021
基金项目: 

江西省科技厅重点研发计划项目 20161BBG70121

江西省卫计委省科技计划项目 20181006

详细信息
    作者简介:

    丁利民,男,1983年生,硕士,主治医师,研究方向为器官移植、普通外科临床及基础研究,Email:dinglimin1203@163.com

    通讯作者:

    罗文峰,男,1974年生,主任医师,研究方向为器官移植、普通外科临床及基础研究,Email: dingzheng1203@163.com

  • 中图分类号: R617, R575.3

Clinical application of ECMO in protecting donor liver in organ donation after citizen's death

More Information
  • 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供肝保护中的可行性。  方法  回顾性分析应用ECMO技术保护供肝的16例肝移植供、受者临床资料。观察ECMO技术对供者各项指标的影响,观察肝移植术后受者的肝功能情况以及预后情况。  结果  与应用ECMO前比较,应用ECMO后供者的心率、总胆红素(TB)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)明显降低,收缩压、舒张压、动脉血氧分压(PaO2)明显升高(均为P < 0.05)。肝移植受者术后肝功能恢复理想,术后7~28 d肝功能逐渐恢复正常。术后3例受者发生并发症,包括移植肝功能延迟恢复1例、胆道狭窄1例、门静脉血栓1例。其中门静脉血栓受者经二次手术取栓后病情不能缓解死亡,其余2例均经对症治疗后康复出院。  结论  公民逝世后器官捐献供者应用ECMO后血流动力学、肝功能等指标均得到明显改善,肝移植受者术后肝功能恢复理想。

     

  • 表  1  DBCD供者应用ECMO前后各项指标的比较

    Table  1.   Comparison of indexes before and after application of ECMO in DBCD donor(x±s)

    指标 ECMO前(n=16) ECMO后(n=16) P
    心率(次/分) 126±7 97±7 < 0.05
    收缩压(mmHg) 82±10 122±5 < 0.05
    舒张压(mmHg) 41±6 74±7 < 0.05
    中心静脉压(cmH2O) 5.5±1.2 11.3±2.7 < 0.05
    PaO2(mmHg) 73±9 155±10 < 0.05
    TB(μmol/L) 54.8±12.7 16.7±1.5 < 0.05
    ALT(U/L) 105.6±26.5 34.4±2.7 < 0.05
    AST(U/L) 82±19 34±4 < 0.05
    10 mmHg=1.33 kPa,1 cmH2O=0.098 kPa
    下载: 导出CSV

    表  2  肝移植受者术后肝功能情况

    Table  2.   Liver function of recipients after liver transplantation(x±s)

    术后时间(d) n TB(μmol/L) ALT(U/L) AST(U/L)
    1 16 85±33 467±280 982±381
    3 16 45±24 387±228 768±145
    5 16 34±9 258±133 453±138
    7 16 23±5 148±85 244±119
    14 16 21±10 50±21 130±51
    28 15 17±2 35±3 35±4
    下载: 导出CSV
  • [1] ZHANG QX, XIE JF, ZHOU JD, et al. Impact factors and attitudes toward organ donation among transplantation patients and their caregivers in China[J]. Transplant Proc, 2017, 49(9):1975-1981. DOI: 10.1016/j.transproceed.2017.09.022.
    [2] 许彪, 王永刚, 牟劲松.体外膜肺氧合在心脏死亡器官捐献供体肝移植中的应用进展[J].器官移植, 2018, 9(6):456-459.DOI: 10.3969/j.issn.1674-7445.2018.06.011.

    XU B, WANG YG, MOU JS. The application progress of extracorporeal membrane oxygenation on liver transplantation from donation after cardiac death[J]. Organ Transplant, 2018, 9(6):456-459.DOI: 10.3969/j.issn.1674-7445.2018.06.011.
    [3] ISNARDI DI, OLIVERO F, LERDA R, et al. Extracorporeal membrane oxygenation as a bridge to organ donation: a case report[J]. Transplant Proc, 2013, 45(7):2619-2620. DOI: 10.1016/j.transproceed.2013.07.015.
    [4] PUŚLECKI M, LIGOWSKI M, STEFANIAK S, et al. " extracorporeal membrane oxygenation for greater poland" program: how to save lives and develop organ donation?[J]. Transplant Proc, 2018, 50(7):1957-1961. DOI: 10.1016/j.transproceed.2018.02.159.
    [5] FAN X, CHEN Z, NASRALLA D, et al. The organ preservation and enhancement of donation success ratio effect of extracorporeal membrane oxygenation in circulatory unstable brain death donor[J]. Clin Transplant, 2016, 30(10):1306-1313. DOI: 10.1111/ctr.12823.
    [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].中华器官移植杂志, 2011, 32(12):756-758.DOI: 10.3760/cma.j.issn.0254-1785.2011.12.014.

    Branch of Organ Transplantation of Chinese Medical Association. Guidelines for cardiac death organ donation in China (2nd edition)[J]. Chin J Organ Transplant, 2011, 32(12):756-758.DOI: 10.3760/cma.j.issn.0254-1785.2011.12.014.
    [7] 袁润强, 宫满成, 董文静, 等.体外膜肺氧合对非可控型心脏死亡器官捐献供肾的保护作用[J].器官移植, 2018, 9(1):74-78.DOI: 10.3969/j.issn.1674-7445.2018.01.011.

    YUAN RQ, GONG MC, DONG WJ, et al. Protective effect of extracorporeal membrane oxygenation on donor kidneys from non-controllable donation after cardiac death[J]. Organ Transplant, 2018, 9(1):74-78. DOI: 10.3969/j.issn.1674-7445.2018.01.011.
    [8] LIU X, WANG B, ZHANG X, et al. Liver transplantation using donation after brain and cardiac death: a single-center experience in China[J]. Transplant Proc, 2016, 48(6):1879-1886. DOI: 10.1016/j.transproceed.2016.03.054.
    [9] CHEN W, YADAV DK, BAI X, et al. Liver transplantation from voluntary organ donor system in China: a comparison between DBD and DCD liver transplants[J]. Gastroenterol Res Pract, 2019:5736702. DOI: 10.1155/2019/5736702.
    [10] 黄东东, 胡泽民, 何坤, 等.公民逝世后器官捐献供肝移植62例临床分析[J/CD].中华普通外科学文献(电子版), 2016, 10(5): 359-362.DOI: 10.3877/cma.j.issn.1674-0793.2016.05.009.

    HUANG DD, HU ZM, HE K, et al. Clinical analysis of 62 cases of liver transplantation from donation after citizen death[J/CD]. Chin Arch Gen Surg (Electr Edit), 2016, 10(5): 359-362. DOI: 10.3877/cma.j.issn.1674-0793.2016.05.009.
    [11] 赵纪强, 霍枫, 李鹏, 等.中国心脏死亡器官捐献工作发展及影响因素: 单中心经验[J/CD].中华移植杂志(电子版), 2017, 11(1): 32-36.DOI: 10.3877/cma.j.issn.1674-3903.2017.01.008.

    ZHAO JQ, HU F, LI P, et al. Development and influence factors of China donation after cardiac death: single-center experience[J/CD]. Chin J Transplant (Electr Vers), 2017, 11(1): 32-36. DOI: 10.3877/cma.j.issn.1674-3903.2017.01.008.
    [12] 隋明昊, 刘蕾, 史源, 等.体外膜肺氧合对心死亡猪的肝脏和胆道的保护和修复作用[J].中华肝胆外科杂志, 2016, 22(8):552-556.DOI: 10.3760/cma.j.issn.1007-8118.2016.08.013.

    SUI MH, LIU L, SHI Y, et al. Repair and protective effect of extracorporeal membrane oxygenation on liver and bile duct after cardiac death of pigs[J]. Chin J Hepatobil Surg, 2016, 22(8):552-556. DOI: 10.3760/cma.j.issn.1007-8118.2016.08.013.
    [13] DALLE AVE AL, SHAW DM, GARDINER D. Extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation or uncontrolled donation after the circulatory determination of death following out-of-hospital refractory cardiac arrest-an ethical analysis of an unresolved clinical dilemma[J]. Resuscitation, 2016, 108:87-94. DOI: 10.1016/j.resuscitation.2016.07.003.
    [14] HAYES D JR, BLACK SM, WHITSON BA. Extracorporeal membrane oxygenation in pediatric organ donation[J]. Pediatr Transplant, 2014, 18(5):549-550. DOI: 10.1111/petr.12304.
    [15] LAZZERI C, BONIZZOLI M, VALENTE S, et al. The role of extracorporeal membrane oxygenation in donation after circulatory death[J]. Minerva Anestesiol, 2014, 80(11):1217-1227.
    [16] BRONCHARD R, DURAND L, LEGEAI C, et al. Brain-dead donors on extracorporeal membrane oxygenation[J]. Crit Care Med, 2017, 45(10):1734-1741. DOI: 10.1097/CCM.0000000000002564.
    [17] JAYARAJAN SN, TAGHAVI S, KOMAROFF E, et al. Impact of extracorporeal membrane oxygenation or mechanical ventilation as bridge to combined heart-lung transplantation on short-term and long-term survival[J]. Transplantation, 2014, 97(1):111-115. DOI: 10.1097/TP.0b013e3182a860b8.
    [18] 隋明昊, 刘蕾, 沈中阳.体外膜肺氧合技术及其在心死亡器官捐献中的应用进展[J].山东医药, 2015, 55(34):101-103.DOI: 10.3969/j.issn.1002-266X.2015.34.045.

    SUI MH, LIU L, SHEN ZY. Progress on extracorporeal membrane oxygenation and its application in cardiac death organ donation[J]. Shandong Med J, 2015, 55(34):101-103.DOI: 10.3969/j.issn.1002-266X.2015.34.045.
    [19] 丁利民, 徐志丹, 李新长, 等.公民逝世后器官捐献供肝保护及功能评估临床分析[J].器官移植, 2017, 8(6):430-434.DOI: 10.3969/j.issn.1674-7445.2017.06.004.

    DING LM, XU ZD, LI XZ, et al. Clinical analysis on donor liver protection and function evaluation for organ donation after citizen's death[J]. Organ Transplant, 2017, 8(6):430-434. DOI: 10.3969/j.issn.1674-7445.2017.06.004.
    [20] DALLE AVE AL, BERNAT JL. Donation after brain circulation determination of death[J]. BMC Med Ethics, 2017, 18(1):15. DOI: 10.1186/s12910-017-0173-1.
    [21] 秦科, 孙煦勇, 董建辉, 等.体外膜肺氧合对循环不稳定脑死亡器官捐献的肝肾功能修复效果[J].中华器官移植杂志, 2017, 38(9):525-530.DOI: 10.3760/cma.j.issn.0254-1785.2017.09.003.

    QIN K, SUN XY, DONG JH, et al. Extra corporeal membrane oxygenation (ECMO) in deceased donors after brain death with severe hemodynamic instability allows to optimize the viability of livers and kidneys procured for transplantation[J]. Chin J Organ Transplant, 2017, 38(9):525-530.DOI: 10.3760/cma.j.issn.0254-1785.2017.09.003.
    [22] 霍枫, 李鹏, 汪邵平.体外膜肺氧合在心脏死亡器官捐献中的应用[J].中华消化外科杂志, 2013, 12(9):648-651. DOI: 10.3760/cma.j.issn.1673-9752.2013.09.003.

    HUO F, LI P, WANG SP. Application of extracorporeal membrane oxygenation on organ donation after cardiacdeath[J]. Chin J Digest Surg, 2013, 12(9):648-651.DOI: 10.3760/cma.j.issn.1673-9752.2013.09.003.
    [23] 何重香, 余红梅, 李宁, 等.体外膜肺氧合在公民逝世后器官捐献中的应用流程与维护[J].武汉大学学报(医学版), 2016, 37(4):565-567, 585.DOI: 10.14188/j.1671-8852.2016.04.012.

    HE CX, YU HM, LI N, et al. Application procedure and maintenance of extracorporeal membrane oxygenation in donation after citizen's death[J]. Med J Wuhan Univ, 2016, 37(4):565-567, 585. DOI: 10.14188/j.1671-8852.2016.04.012.
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出版历程
  • 收稿日期:  2019-07-08
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2019-09-15

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