体外膜肺氧合用于脑心双死亡供者器官获取的流程和方法

The procedure and method of extracorporeal membrane oxygenation support donation after brain death followed by cardiac death

目的总结体外膜肺氧合（ECMO）用于脑心双死亡供者（DBCD）器官获取的流程和方法。方法回顾分析2009年1月至2012年12月完成的39例DBCD器官捐赠。39例供者中，男性30例，女性9例，年龄（28．1±10．2）岁，体质量指数为（21．3±2．5）kg／m2；原发病为重型脑外伤29例，脑血管意外8例，以及缺血缺氧性脑病2例。评估供者危险指数为1．27±0．28。39例供者在捐赠器官过程中均使用了ECMO支持。结果ECMO使用时间为（161±77）min。ECMO起始流量为（3．14±0．24）L／min，平衡流量为（1．76±0．58）L／min，复灌流量为（3．10±0．48）L／min。供者器官热缺血时间均为0min。供者评估时、ECMO使用前、器官获取前供者胆红素总量、丙氨酸转氨酶均无显著性差异，但获取前血清肌酐水平显著升高，尿量显著减少。共获取38个肝脏，78个肾脏，分别实施了37例肝移植、64例肾移植。1个肝脏因合并乙型肝炎病毒表面抗原阳性未匹配到合适受者而未使用，14个肾脏因肾功能不全、肾结石未使用。结论供者家属和伦理委员会对使用ECMO没有争议，ECMO辅助DBCD器官获取可避免热缺血损伤，获得更满意的移植效果。

Objective To summarize the procedure and method of extracorporeal membrane oxygenation （ECMO） support donation after brain death followed by cardiac death （DBCD）. Method The clinical data,the selected standard and the organ procurement procedure of 39 DBCD cases were retrospectively analyzed from January 2009 to December 2012 in our liver transplantation center, including 30 males and 9 females with the mean age and mean BMI of 28. 1 ±10. 2 and 21.3±2.5 respectively. The primary diseases included head trauma （29 cases）, intracranial bleeding （8 cases）, and anoxia （2 cases）. The mean DRI was 1. 27±0. 28. ECMO was introduced in all the donors. Result The mean length of ECMO time was 161 77 min. The initial, balance and reperfusion value of ECMO volume was 3.14±0. 24,1.76±0. 58 and 3.10±0. 48 L/min respectively. All the donors had no warm ischemia time. The TBIL and ALT showed no significant difference in all the donors when estimated, before the ECMO started and before the organ procurement, hut the Cr was increased and urine output decreased significantly. All the donated organs included 38 livers,and 78 kidneys. Thirty-seven cases of liver transplantation and 64 cases of kidney transplantation were performed finally. One liver out of the 38 cases was unused due to the positive HbsAg, and 14 kidneys unused due to renal insufficiency and kidney stones. Conclusion There is no dispute in the ethics Committee and all the donor＇s family members about the usage of ECMO. The ECMO support DBCD could well control the warm ischemia, and obtain satisfactory curative effect of transplantation.