心脏死亡器官捐献供体维护的体会

The experience for maintenance of cardiac death organ donation

目的参照国外脑死亡供者维护经验,结合我国实际情况,逐步探索符合我国国情的供体维护方式。方法检索国外脑死亡器官捐献(DBD)供体维护文献,结合吉林大学第一医院心脏死亡器官捐献(DCD)供者的病情,分别加强供者脑死亡期间管理,提高供体捐献率和供器官利用率的方法。结果吉林大学第一医院2011年8月至2012年8月共完成15例DCD,经过血管活性药物维持血压、心率,积极纠正水、电解质紊乱及酸碱失衡,维持生命体征、尿量等措施,15例供体均完成捐献,共捐献肝脏12个、肾脏22个。1例供体因心肺复苏过程中有30分钟低血压过程,肾移植受者术后发生移植肾功能延迟恢复(DGF)和移植肾功能缓慢恢复(SGF);1例62岁供体因有长期高血压、多次脑出血病史,致使肝脏受者术后发生原发性肝脏无功能(PNF)、继发肾功能衰竭死亡;其余器官质量良好,受者移植术后恢复顺利,随访至今移植物功能良好。结论DCD是我国器官移植的必由之路,加强供体脑死亡期间的器官功能维护,提高器官利用率,对于挽救更多终末期器官衰竭患者的生命具有重要意义。

Objective To explore the preservation way of donor suitable for Chinese practice with reference to foreign maintenance experience of brain-dead donor. Methods Foreign maintenance documents of brain-dead organ donation(DBD)donor were reviewed and combined with the conditions of donors after cardiac death (DCD)in the First Hospital of Jilin University to improve the donation rates and the utilization ratio of organ donors by strengthening the management during brain-dead period. Results 15 cases of cardiac death organ donation had been done from August 2011 to August 2012 in the First Hospital of Jilin University. Vasoactive agents were used to maintain blood pressure,heart rate,and water,electrolyte and acid-base imbalance were corrected aggressively, vital signs and urineoutput were maintained. 15 cases of donor completed donation successfully by donating a total of 12 livers and 22 kidneys. 1 case of donor underwent delayed graft function(DGF)and slow graft function(SGF) after renal transplantation because of the low blood pressure lasting 30 minutes in the process of cardiopulmonary resuscitation(CPR). Another transplant recipient died of the postoperative liver recipients of primary liver function (PNF)and secondary renal failure because the 62-year-old donor had long-term hypertension and the medical history of cerebral hemorrhage for many times. All other organs were good in quality. The recipients recovered smoothly after transplantation, follow-up so far showed that the grafts functioned well. Conclusion Cardiac death organ donation is the only way for organ transplantation in our country,which is of great significance to save more patients with end-stage organ failure by strengthening the management of brain-dead donor and improving the utilization rate of the organ.