采用连续性肾脏替代治疗对脑-心双死亡器官捐赠供者高钠血症的临床效果  

The clinical effect of continuous renal replacement therapy in brain death donors with hypernatremia

作　　者：陈统清[1] 林敏娃[1] 申伟[1] 洪汉利[1] 孔耀中[1] 温振英[1] 李燕[1] 誉铁鸥[1] 方滨[1] 

机构地区：[1]佛山市第一人民医院肾内科,广东省佛山市528000

出　　处：《中华器官移植杂志》2014年第5期270-272,共3页Chinese Journal of Organ Transplantation

摘　　要：目的探讨合并重度高钠血症的脑-心双死亡器官捐献（DBCD）供者在脑死亡后接受连续性肾脏替代治疗（CRRT）对控制血钠水平的效果及安全性。方法回顾性分析2011年9月至2013年10月8例合并重度高钠血症的DBCD供者的临床资料。8例供者均为男性，年龄（36．3±12．2）岁，原发病为自发性脑出血4例、重度颅脑外伤3例及晚期脑肿瘤1例，明确诊断为脑死亡。8例供者血钠≥160．0mmol／L，须要血管活性药物去甲肾上腺素维持血压，内科常规治疗12h后血钠水平无下降趋势，然后接受了CRRT。监测应用CRRT期间供者的尿量、血钠、血肌酐、中心静脉压及平均动脉压的变化。结果8例供者接受CRRT治疗的时间为（25．3±11．3）h，血钠水平由治疗前的（177．4±9．7）mmol／L降至（156．1±6．2）mmol／L，平均每小时下降0．85mmol／L，血钠水平得到明显纠正（P〈0．05），同时供者的高氯血症和低钾血症亦得到纠正；在接受CRRT过程中，供者的尿量、血压、中心静脉压未发现明显变化，去甲肾上腺素的用量稍有减少。8例供者均按照中国心脏死亡器官捐献工作指南（第2版）中的中国三类标准成功捐赠器官，所获器官均成功进行了移植手术，移植后未发生移植物功能不全。结论合并重度高钠血症的DBCD供者在脑死亡后接受CRRT控制血钠水平是安全、有效的。Objective To investigate the effect and security of continuous renal replacement therapy （CRRT） in brain death donors with hypernatremia. Method All the patients were treated with continuous renal replacement therapy. Before and after CRRT, levels of main biochemical indicators in plasma （sodium and creatinine） were measured, and the urine volume, mean arterial pressure and central venous pressure were recorded. Result Totally 8 brain death donors were enrolled. The mean time of CRRT treatment was （25.3 ± 11.3） h. The levels of blood sodium were reduced from 177. 4 ± 9. 7 to 156. 1± 6. 2 mmol/L, and the mean rate of blood sodium change was 0. 85 mmol/L per h. Meanwhile, hyperchloremia and hypokalemia got improved. During the treatment time, the urine volume, mean arterial pressure and central venous pressure had no significant change, and the dose of norepinephrine got decreased. Eight donors had all donated organs successfully, and all practiced the third organ procurement process of Chinese donation after cardiac death （DCD） guideline. All the donated organs were transplanted and functions of allografts-were fine. Conclusion CRRT is a safe and effective measure for the treatment of brain death donors with hypernatremia.

关 键 词：供者 脑死亡 高钠血症 连续性肾脏替代治疗 

分 类 号：R617[医药卫生—外科学]