多次心肺复苏后心脏死亡供者在体外膜肺氧合支持下捐肾一例报告  

A successful kidney donor after several times cardiopulmonary resuscitation requiring extracorporeal membrane oxygenation support

作　　者：潘灵爱[1] 黎嘉嘉[1] 黄晓波[1] 

机构地区：[1]四川省人民医院,成都610072

出　　处：《中华器官移植杂志》2016年第6期344-347,共4页Chinese Journal of Organ Transplantation

摘　　要：目的探讨多次心肺复苏后心脏死亡供者应用ECMO对器官的保护效果及移植效果。方法回顾分析1例经历多次心跳骤停和心肺复苏后以及应用体外膜肺氧合（ECMO）支持下器官保护的心脏死亡供者的病例资料。供者为男性，44岁，因“脑干出血、右侧小脑血肿、蛛网膜下腔出血、脑疝”于2015年7月20日人当地医院后发生心跳骤停，行首次心肺复苏；供者病情进展迅速，于2015年7月22日转入四川省人民医院，当天15：55再次发生心率、血压、氧饱和度下降，立即给予心外按压，至16：30供者自主心率恢复至123次／min。在完善器官捐献法律文书过程中，供者于16：40再次发生心跳骤停，再次给予心肺复苏，并决定立即行床旁ECMO支持心肺功能，保护肝、肾等重要器官，因供者在抢救过程中自主心率一直未恢复，应用心肺复苏机持续给予心外按压持续4h。供者于21：00心脏死亡，获取供者2只供肾，并分别移植给2例受者。结果获取供者2只供肾，并分别移植给2例受者。2例受者肾移植术后早期均发生了移植肾功能恢复延迟（DGF），均给予规律透析治疗。1例受者于术后13d发生严重感染，于术后19d因感染性休克而死亡，死亡前血肌酐水平为111．7tzmol／L。另1例受者术后恢复良好，术后1个月左右移植肾功能逐渐恢复正常；术后2个月后受者完全脱离透析治疗，复查血肌酐水平为166．9μmol／L。结论ECMO结合心肺复苏机可以为心脏死亡供者提供有效的循环支持，起到良好器官保护作用。在ECMO支持下，多次心跳骤停及长时间应用心肺复苏机后心脏死亡供者供肾用于移植可以获得良好效果。Objective To investigate the protective effect of extracorporeal membrane oxygenation （ECMO） in on the organs of the potential donor. Methods One patient with cardiac arrest for more than 4 h and the protection of the organ by cardiopulmonary resuscitation machine and ECMO was retrospectively reviewed. The donor was male with 44 years old, who had a cardiac arrest because of ＂brainstem hemorrhage, right cerebellar hematoma, subarachnoid hemorrhage, hernia＂ in the local hospital in July 20, 2015. After the first successful cardiopulmonary resuscitation he was transferred to our hospital in July 22, 2015. He had a heart arrest again at 15：55, and after CPR the heart rate returned to 123 beats/min at 16：30. At 16：40 he had heart arrest again, and the ECMO treatment was given to protect the liver and the kidneys, and the long time of CPR was given for 4 h with the CPR machine. The donor died at 21：00, and the kidney transplantation was performed on two patients. Results In this case, 2 kidneys were successfully donated, but two kidneys had DGF and accepted CRRT. One of them had severe infection 13 days after transplantation, who died 19 days after surgery because of septic shock. The creatnine was 111.7 μmol/L when she died. The renal function of the other patient was gradually restored, the renal function was getting well one month after surgery, CRRT stopped 2 months later, and the creatnine was 166. 9 μmol/L. Conclusion ECMO combined with cardiopulmonary resuscitation machine can provide effective circulatory support for organ donors, which plays a good role in organ protection.

关 键 词：供者 心肺复苏 膜肺氧合 器官保护 

分 类 号：R699.2[医药卫生—泌尿科学]