静脉-动脉体外膜氧合支持下器官捐献供体脑死亡判定的临床分析  

Clinical analysis of brain death determination in organ donors under veno-arterial extracorporeal membrane oxygenation assisted circulatory support

作　　者：沈松颖 贾美云 王红[1] 赵云峰 董慧君 赵贺 秦威 秦兴松 赵萌 刘亚杰 王红宇 Shen Songying;Jia Meiyun;Wang Hong;Zhao Yunfeng;Dong Huijun;Zhao He;Qin Wei;Qin Xingsong;Zhao Meng;Liu Yajie;Wang Hongyu(Organ Transplant Center,Zhengzhou People's Hospital/Zhengzhou People's Hospital,Henan University of Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学人民医院/郑州人民医院器官移植中心,郑州450000

出　　处：《中华神经医学杂志》2024年第4期392-396,共5页Chinese Journal of Neuromedicine

摘　　要：目的总结静脉-动脉体外膜氧合(VA-ECMO)辅助循环支持下脑死亡判定经验,尤其是自主呼吸激发试验(AT)注意事项,为该场景下脑死亡判定提供参考。方法郑州人民医院器官移植中心自2019年10月至2023年12月行VA-ECMO治疗的患者共78例,其中VA-ECMO支持下进行脑死亡判定的器官捐献供体共8例。收集该8例患者的基线资料、临床数据及AT试验的VA-ECMO数据,总结分析其脑死亡判定过程。结果8例供体患者中有6例患者符合脑死亡判定,共进行10次脑电图、12次诱发电位和15次AT试验。AT判定过程中的并发症包括低血压、氧合下降、心律失常等,经过及时提高VA-ECMO流量、应用强心及升压药物等治疗后均缓解。结论AT试验是VA-ECMO供体脑死亡判定的难点,需密切监测和处理可能出现的并发症。Objective To summarize the experience of brain death determination under veno-arterial extracorporeal membrane oxygenation(VA-ECMO)assisted circulatory support,especially apnea test(AT)precautions,and to provide references for brain death determination in this scenario.Methods In 78 patients who had VA-ECMO at Organ Transplant Center,Zhengzhou People's Hospital from October 2019 to December 2023,8 organ donors had brain death determination under VA-ECMO assisted circulatory support.Baseline data,clinical data,and VA-ECMO data during AT trial were collected from these 8 patients to summarize the process of brain death determination.Results Six of the 8 donors met the criteria of brain death;10 EEG,12 evoked potentials and 15 ATs were performed.Complications in ATs,including hypotension,decreased oxygenation and arrhythmia,were alleviated after timely improved VA-ECMO flow and applied cardiotonic and pressor drugs.Conclusion AT is key for successful brain death determination in organ donors under VA-ECMO assisted circulatory support;therefore,complications should be closely monitored and managed.

关 键 词：体外膜氧合 器官捐献 脑死亡 自主呼吸激发试验 供体 

分 类 号：R617[医药卫生—外科学]