ECMO技术在公民逝世后器官捐献供肝保护中的临床应用  

Clinical application of ECMO in protecting donor liver in organ donation after citizen’s death

作　　者：丁利民[1] 李新长[1] 徐志丹[1] 杨小刚[1] 黄小梅[1] 罗文峰[1] Ding Limin;Li Xinchang;Xu Zhidan;Tang Xiaogang;Huang Xiaomei;Luo Wenfeng(Department of Organ Transplantation,Jiangxi Provincial People's Hospital, Nanchang 330006,China)

机构地区：[1]江西省人民医院器官移植科

出　　处：《器官移植》2019年第5期594-598,共5页Organ Transplantation

基　　金：江西省科技厅重点研发计划项目(20161BBG70121);江西省卫计委省科技计划项目(20181006)

摘　　要：目的探讨体外膜肺氧合(ECMO)技术在公民逝世后器官捐献供肝保护中的可行性。方法回顾性分析应用ECMO技术保护供肝的16例肝移植供、受者临床资料。观察ECMO技术对供者各项指标的影响,观察肝移植术后受者的肝功能情况以及预后情况。结果与应用ECMO前比较,应用ECMO后供者的心率、总胆红素(TB)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)明显降低,收缩压、舒张压、动脉血氧分压(PaO2)明显升高(均为P<0.05)。肝移植受者术后肝功能恢复理想,术后7~28 d肝功能逐渐恢复正常。术后3例受者发生并发症,包括移植肝功能延迟恢复1例、胆道狭窄1例、门静脉血栓1例。其中门静脉血栓受者经二次手术取栓后病情不能缓解死亡,其余2例均经对症治疗后康复出院。结论公民逝世后器官捐献供者应用ECMO后血流动力学、肝功能等指标均得到明显改善,肝移植受者术后肝功能恢复理想。Objective To explore the feasibility of extracorporeal membrane oxygenation(ECMO) in protecting the donor liver in donation after citizen’s death. Methods Clinical data of 16 donors and recipients undergoing liver transplantation using ECMO to protect the donor liver were retrospectively analyzed. The effect of ECMO on different indicators of the donors was evaluated. The liver function and clinical prognosis of the recipients after liver transplantation were observed. Results Compared with the time before ECMO, the heart rate, total bilirubin(TB), alanine transaminase(ALT) and aspartate transaminase(AST) of the donors after ECMO were significantly reduced, whereas the systolic blood pressure, diastolic blood pressure and partial pressure of arterial oxygen(PaO2) were remarkably increased(all P<0.05). The liver function of the recipients was properly recovered after liver transplantation, and gradually restored normal at postoperative 7 to 28 d. Postoperative complications occurred in 3 recipients, including delayed liver function recovery in 1 case, biliary tract stenosis in 1 case and portal vein thrombosis in 1 case. Among them, the patient with portal vein thrombosis died after secondary operation, and the other 2 patients were recovered and discharged after symptomatic treatment. Conclusions The hemodynamics, liver function and other indicators of donors from donation after citizen’s death are significantly improved after ECMO, and the liver function of the recipients also recover well.

关 键 词：体外膜肺氧合 公民逝世后器官捐献 脑-心双死亡器官捐献(DBCD) 肝移植 供肝保护 肝功能 胆道狭窄 门静脉血栓 

分 类 号：R617[医药卫生—外科学] R575.3[医药卫生—临床医学]