脑死亡心脏供体的评估和管理方法探索  

Evatuation and management of donor hearts from brain death

作　　者：周巍[1] 孔祥荣[1] 王凯[1] 柴军武[1] 陈洪磊[1] 薛奋龙 王维铁 Zhou Wei, Kong Xiangrong, Wang Kai, Chai Junwu, Chen Honglei, Xue Fenlong, Wang Weitie.(Cardial Surgery, Tianjin First Center Hospital, Tianjin 300192, China)

机构地区：[1]天津市第一中心医院心外科,天津300192

出　　处：《实用器官移植电子杂志》2018年第1期39-44,共6页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：器官移植科国家临床重点专科建设项目(2013544)

摘　　要：目的总结分析天津市第一中心医院37例脑死亡器官捐献供者供心的评估及维护经验。方法回顾性分析2013年1月-2017年6月天津市第一中心医院心外科完成的37例脑死亡器官捐献供心的评估、获取及移植手术的临床资料。供心来源于器官获取组织主导的公民器官捐献,脑死亡供者根据《中国脑死亡判定标准(成人)》进行判定。结果手术方法均采用双腔静脉法原位心脏移植术。冷缺血时间45~370分钟,阻断时间55~110分钟,体外循环时间125~190分钟。36例患者手术过程顺利,1例供体体重小于受体体重30%,术后出现心功能不全,术后通过体外膜肺氧合(ECMO)联合主动脉内球囊反搏(IABP),肾脏替代治疗(CRRT)1周后恢复。结论对于供体及受体的综合评估,有效的心脏供体管理措施,可以提高心脏供体利用率,改善心脏移植远期生存率。Objective To summarize the experience of donor heart evaluation and function maintenance from 37 cases of donation after brain death in our hospital. Methods From January 2013 to June 2017, 37 cases of heart donation after brain death were evaluated in cardial surgery department, Tianjin First Center Hospital. Donor hearts were fromorgan donation from organ procurement organization（OPO）, and the diagnoses of brain death were based on the China brain death criteria（adult）. Results Transplantations were all performed with a double lumen venous anastomosis manner. The cold ischemia time was（45 ~ 370）min, aorta cross-clamping time was（55 ~110）min and cardiopulmonary bypass time was（125 ~ 190）min. The operations were successful in 36 patients. A cardiac dysfunction occurred after operation in 1 case whose body weight was 30% less than the donor. The patient recovered after treated with extracorporeal membrane oxygenation（ECMO）, intra-aortic balloon pump（IABP） and continuous renal replacement therapy（CRRT） 1 week later. Conclusion We can improve the utilization of donor hearts andthe long-term survival of heart transplantation recipients by a comprehensive evaluation of the donor and recipient.

关 键 词：器官捐献 评估标准 供者维护 心脏移植 

分 类 号：R654.2[医药卫生—外科学]