亚低温结合体外膜氧合在器官捐献供肾肾移植中的应用  

Application of mild hypothermia plus extracorporeal membrane oxygenation in donor kidney transplantation with circulatory unstable death organ donation

作　　者：黄莹[1] 孙煦勇 秦科[1] 董建辉 曹嵩 雷志影 Huang Ying;Sun Xuyong;Qin Ke;Dong Jianhui;Cao Song;Lei Zhiying(Department of Organ Transplantation,Second Affiliated Hospital of Guangxi Medical University,Nanning 530022,China;Institute of Transplant Medicine,the 923 Hospital of PLA Joint Logistics Support Force,Guangxi Key Laboratory for Transplantation Medicine,Guangxi Transplantation Medicine Research Center of Engineering Technology,Nanning 530021,China)

机构地区：[1]广西医科大学第二附属医院器官移植科,南宁530022 [2]中国人民解放军联勤保障部队第九二三医院移植医学研究院,广西移植医学重点实验室,广西移植医学工程技术研究中心,南宁530021

出　　处：《中华器官移植杂志》2021年第3期158-162,共5页Chinese Journal of Organ Transplantation

基　　金：国家自然基金面上项目(81670596);广西科学技术开发与研究项目(桂科攻14124003-8)。

摘　　要：目的探讨亚低温结合体外膜氧合(ECMO)应用于脑死亡供者肾移植中对肾脏的保护作用。方法回顾性分析2017年7月至2018年7月间中国人民解放军联勤保障部第九二三医院的29例循环功能不稳定脑死亡供者及对应的57例受者的临床资料,根据ECMO支持的处理方式不同随机分为亚低温组(体温34.0~35.0℃,15例)和常温组(36.5~37.5℃,14例)。比较两组供者使用ECMO期间血流动力学、肾功能变化,以及随访两组相对应的受者移植肾功能恢复情况。结果两组供者使用ECMO期间血流动力学指标均趋于稳定,亚低温组ECMO 5 h至器官获取前心率低于常温组差异有统计学意义(P<0.05),ECMO 3 h至器官获取前收缩压、舒张压均高于常温组(P<0.05),氧分压(PaO2)与常温组差异无统计学意义(P>0.05)。亚低温组使用ECMO期间供者肌酐、尿素氮低于常温组(P<0.05)。亚低温组受者术后尿素氮水平低于常温组(P<0.05),肌酐与常温组差异无统计学意义(P>0.05)。亚低温组受者术后住院时间(16.52±3.59)d,低于常温组差异有统计学意义(P<0.05),移植肾功能延迟恢复发生率低于常温组(3.45%和21.43%,P<0.05)。结论亚低温结合ECMO可降低脑死亡后循环不稳定的供者血流动力学波动,改善供肾功能,降低肾移植后功能延迟恢复发生率。Objective To explore the protective effect of hypothermia plus extracorporeal membrane oxygenation(ECMO)on kidney in brain-dead kidney transplant donors.Methods From July 2017 to July 2018 at Institute of Transplantation Medicine,Hospital No.923 of PLA,29 patients with circulatory dysfunction brain death donors fulfilling the organ donation criteria were randomly divided into sub-hypothermia group according to the treatment of extracorporeal membrane oxygenation(body temperature 34.0~35.0℃,15 cases)and normal temperature group(36.5~37.5℃,14 cases).Hemodynamic profiles and renal function changes were compared between two groups during ECMO.And renal complications of two groups were followed up.Results The hemodynamic parameters of two groups remained stable during ECMO period.Heart rate of 5 MO-organs was lower in hypothermia group than that in normal temperature group(P<0.05).Systolic and diastolic pressures before ECMO 3 h-organ acquisition were higher than normal temperature group(P<0.05).No significant difference existed between PaO2 and normal temperature groups(P>0.05).Donor serum creatinine(SCr)and blood urea nitrogen(BUN)were lower in hypothermia group than in normal temperature group(P<0.05).The postoperative recipient levels of BUN were lower in mild hypothermia group than those in normothermia group(P<0.05)and no significant difference between SCr and normal temperature groups(P>0.05).The postoperative hospital stay was(16.52±3.59)days in mild hypothermia group.And it was lower than that in normal temperature group(P<0.05).Delayed renal function was lower than normal temperature group(3.45%and 21.43%,P<0.05).Conclusions Mild hypothermia plus ECMO can reduce hemodynamic fluctuations in circulatory unstable donors after brain death,improve renal function and lower the incidence of delayed functional recovery after renal transplantation.

关 键 词：肾移植 脑死亡 体外膜氧合 

分 类 号：R699.2[医药卫生—泌尿科学]