体外膜肺氧合用于循环功能不稳定的中国一类捐赠者的器官保护三例  

Organ protective effect of ECMO for donors after brain death presented with hemodynamic instability

作　　者：孙煦勇[1] 秦科[1] 董建辉[1] 农江[1] 赖彦华[1] 聂峰[1] 蓝柳根[1] 周洁蕙 黄晨[1] 李壮江[1] 蓝倩[1] 陈文斗[1] 曲海燕[1] 赵东海[1] 

机构地区：[1]解放军第三.三医院器官移植中心广州军区肝肾移植中心广西移植医学重点实验室 ,南宁530021

出　　处：《中华器官移植杂志》2012年第11期657-660,共4页Chinese Journal of Organ Transplantation

基　　金：基金项目：广西科学研究与技术开发计划（10169-05,桂科攻0993003A-17）

摘　　要：目的观察体外膜肺氧合（ECMO）应用于循环功能不稳定的中国一类器官捐赠者的器官保护效果。方法3例符合“中国心脏死亡器官捐献分类标准”中国一类标准的捐赠者，在器官获取前血流动力学极不稳定，部分器官功能出现不同程度受损。经股动、静脉插管，采用静脉-动脉转流，行ECMO。根据体重、血流动力学及血液气体分析结果，调整ECMO流量。转流时间为6～12h，之后获取肝脏和。肾脏用于移植。结果3例行ECMO转流期间，血流动力学逐步稳定，血管活性药物应用明显减少，甚至停用，受损的器官功能明显恢复，最终获取肾脏6个和肝脏2个用于移植。6例肾移植受者手术顺利，术后发生原发性移植肾功能恢复延迟2例，急性排斥反应2例，移植肾功能恢复良好。结论对于血流动力学不稳定的中国一类捐赠者，ECMO是保护器官的有效手段。Objective To examine the benefits of ECMO for potential organ donors with hemodynamic instability after brain death. Methods Three brain-dead potential donors who presented with hemodynamic instability despite maximal medical management, finished a declaration of brain death, that were supported by extracorporeal circulation membrane oxygenation （ECMO）. Results Donor organs, including six kidneys, and two livers, were harvested from the three donors under ECMO support, leading to 8 successful transplantations. The organs functioned well and the recipients made full recoveries. Conclusion Our experience indicates that ECMO allows for the maintenance of abdominal organ tissue perfusion without warm ischemia before organ procurement, providing sufficient time for safe organ donation procedures and reducing the risk of unpredictable cardiac arrest that could result in the donor death and graft loss.

关 键 词：辅助循环 体外膜氧合作用 心脏死亡 供者 肾移植 肝移植 

分 类 号：R617[医药卫生—外科学]