体外膜肺氧合技术对脑心双死亡器官捐献供肝的保护作用

丁利民; 李新长; 罗文峰; 杨小刚; 黄小梅; 徐志丹

doi:10.3969/j.issn.1001-5256.2020.01.032

体外膜肺氧合技术对脑心双死亡器官捐献供肝的保护作用

DOI: 10.3969/j.issn.1001-5256.2020.01.032

江西省人民医院器官移植科

基金项目:

江西省科技厅重点研发计划项目(20161BBG70121);江西省科技厅自然科学计划项目(20192BAB205021)；江西省卫健委省科技计划项目(20181006)；

详细信息

中图分类号: R657.3
计量
- 文章访问数: 948
- HTML全文浏览量: 33
- PDF下载量: 212
- 被引次数: 0
出版历程
- 收稿日期: 2019-07-23
- 出版日期: 2020-01-20

Clinical effect of extracorporeal membrane oxygenation in donor liver protection during donation after brain and cardiac death

Department of Organ Transplantation,Jiangxi Provincial People's Hospital

Research funding:

摘要

摘要: 目的探讨体外膜肺氧合（ECMO）技术在公民逝世器官捐献供肝保护中的应用,总结ECMO技术保护供肝的初步体会及经验。方法收集江西省人民医院2015年1月-2018年12月运用ECMO技术完成脑心双死亡器官捐献（DBCD）肝移植供者/受者及常规DBCD肝移植供者/受者的临床资料,对供肝的保护及移植效果进行对比分析。计量资料两组间比较采用t检验;计数资料两组间比较采用χ2检验。结果共纳入一般情况及肝功能接近的供者32例,根据采用的方法将其分为对照组（常规DBCD肝移植）和研究组（运用ECMO技术完成DBCD肝移植）,每组各16例; 32例肝移植受者分为对应的对照组（n=16）和研究组（n=16）。器官获取前供者对照组与供者研究组比较,心率、收缩压、舒张压、血氧分压、乳酸水平、中心静脉压、TBil、ALT、AST差异均有统计学意义（t值分别为14. 121、-17. 817、-19. 187、-8. 927、4. 559、-3. 495、3. 357、4. 111、3. 553,P值均<0. 05）。与受者对照组术后第7天肝功能相比,受者研究组肝移植术后肝功能恢复速度更快,两组TBil、...
- 肝移植 /
- 体外膜肺氧合 /
- 脑心双死亡器官捐献 /
- 治疗结果
Abstract: Objective To investigate the application of extracorporeal membrane oxygenation(ECMO) in donor liver protection during donation after death,and to summarize the preliminary experience in the application of ECMO in donor liver protection. Methods Clinical data were collected from liver transplantation donors/recipients who received ECMO during donation after brain and cardiac death(DBCD)and those who received conventional DBCD liver transplantation,and a comparative analysis was performed for donor liver protection and outcome of transplantation. The t-test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. Results A total of 32 donors with similar general status and liver function were enrolled and divided into control group(conventional DBCD liver transplantation) and experimental group(DBCD liver transplantation with ECMO),with 16 donors in each group. A total of 32 liver transplantation recipients were divided into corresponding control group and experimental group,with 16 recipients in each group. There were significant differences between the donor control group and the donor experimental group in heart rate,systolic pressure,diastolic pressure,partial pressure of blood oxygen,lactate level,central venous pressure,total bilirubin(TBil),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)(t = 14. 121,-17. 817,-19. 187,-8. 927,4. 559,-3. 495,3. 357,4. 111,and 3. 553,all P < 0. 05). Compared with the recipient control group on day 7 after surgery,the recipient experimental group had significantly faster recovery of liver function after liver transplantation using the ECMO technique,and there were significant differences between the two groups in TBil,DBil,ALT,AST,alkaline phosphatase,and gamma-glutamyl transpeptidase(t =9. 309,4. 783,5. 067,2. 203,4. 774,and 5. 257,all P < 0. 05). The recipient experimental group had a significantly shorter length of hospital stay than the recipient control group(20. 87 ± 4. 98 d vs 12. 65 ± 2. 86 d,t = 5. 756,P < 0. 001). Conclusion Liver transplantation using the ECMO technique has a good clinical effect,and scientific and rational use of ECMO can effectively improve the quality of donor liver. Therefore,it plays an active role in organ donation after Chinese citizen death.
- liver transplantation /
- extracorporeal membrane oxygenation /
- donation after brain death plus cardiac death /
- treatment outcome

HTML全文

参考文献(18)

[1] LPEZ-NAVIDAD A,CABALLERO F,GUIRADO L,et al.The medical-nursing team specialized in the maintenance of the brain-dead heart-beating organ donor exclusively dedicated to caring for the donor reduces donor loss from asystolia to zero[J]. Transplant Proc,2002,34(1):20-22.

[2] LYU GY,QIU W. Clinical progress in donation after cardiac death liver transplantation in China[J]. J Clin Hepatol,2014,30(1):11-13.(in Chinese)吕国悦，邱伟．我国心脏死亡器官捐献供肝现状及其肝移植的临床进展[J]．临床肝胆病杂志，2014,30(1):11-13.

[3] XU B,WANG YG,MU JS. Progress in the application of extracorporeal membrane oxygenation in donor liver transplantation[J]. Ogran Transplantation,2018,9(6):456-459.(in Chinese)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.

[4] Organ Transplantation Branch of Chinese Medical Association.Guidelines for organ donation of cardiac death in China(2nd Edition)[J]. Chin J Organ Transplant,2011,32(12):756-758.(in Chinese)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.

[5] CHENG J,LV Y. Pre-retrieval reperfusion decreases cancer recurrence after rat ischemic liver graft transplantation[J]. J Hepatol,2014,61(4):962.

[6] Organ Transplant Branch of Chinese Medical Association,Organ Transplant Branch of Chinese Medical Association. Expert consensus on the application of extracorporeal membrane oxygenation in organ protection after the death of Chinese citizens(2016 Edition)[J/CD]. Chin J Transplant(Electronic Edition),2016,10(3):107-111.(in Chinese)中华医学会器官移植学分会，中国医师协会器官移植医师分会．体外膜肺氧合在中国公民逝世后捐献供器官保护中的应用专家共识(2016版)[J/CD]．中华移植杂志(电子版)，2016,10(3):107-111.

[7] HUO F,WANG SP,LI P,et al. The procedure and method of extracorporeal membrane oxygenation support donation after brain death followed by cardiac death[J]. Chin J Organ Transplant,2013,34(7):396-400.(in Chinese)霍枫，汪邵平，李鹏，等．体外膜肺氧合用于脑心双死亡供者器官获取的流程和方法[J]．中华器官移植杂志，2013,34(7):396-400.

[8] MIAO MQ,MA XP,MAO F,et al. Research progress of extracorporeal membrane oxygenation in liver transplantation using donation after cardiac death[J]. China Med Herald,2018,15(12):28-31.(in Chinese)缪朦秋，马雪萍，毛菲，等．体外膜肺氧合在心脏死亡供体肝移植中的应用进展[J]．中国医药导报，2018,15(12):28-31.

[9] 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.(in Chinese)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.

[10] TANAKA K,OGURA Y．“Small-for-size graft”and“smallfor-size syndrome”in living donor liver transplantation[J].Yonsei Med J,2004,45(6):1089-1094.

[11] XIE EB,XUAN FH,SUN XD,et al. An analysis of risk factors for early complications after liver transplantation[J]. J Clin Hepatol,2018,34(6):1282-1288.(in Chinese)解恩博，轩凤慧，孙晓东，等．肝移植术后早期并发症的危险因素分析[J]．临床肝胆病杂志，2018,34(6):1282-1288.

[12] MARCOS A. Right lobe living donor liver transplantation:A review[J]. Liver Transpl,2000,6(1):3-20.

[13] DING LM,XU ZD,LI XC,et al. Clinical analysis on donor liver protection and function evaluation for organ donation after citizen’s death[J]. Ogran Transplantation,2017,8(6):430-434.(in Chinese)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.

[14] 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 General Surg(Electronic Version),2016,10(5):359-362.(in Chinese)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.

[15] DESAI CJ. Selection and maintenance of a cadaver donor for liver transplantation[J]. Apollo Med,2012,9(1):9-16.

[16] 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.(in Chinese)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.

[17] HUANG Y,HUANG D,WENG JF,et al. Liver transplantation from elderly donor:Current research status and feasibility[J].Chin J Gen Surg,2014,23(7):961-966.(in Chinese)黄宇，黄迪，翁杰锋，等．运用高龄供肝移植的研究现状及其可行性[J]．中国普通外科杂志，2014,23(7):961-966.

[18] HUO F,LI P,WANG SP. Application of extracorporeal membrane oxygenation on organ donation after cardiac death[J].Chin J Dig Surg,2013,12(9):648-651.(in Chinese)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.

施引文献

资源附件(0)

访问统计