公民逝世后器官捐献供者脑源性胰腺炎32例的诊治观察

Preliminary observation on 32 cases of brain injury-induced acute pancreatitis in donors from donation after citizen death

目的观察公民逝世后器官捐献（DCD）供者脑源性胰腺炎的诊治及对器官的维护作用。方法分析2011年7月至2015年6月32例捐献器官前并发生脑源性胰腺炎的ISX2D供者临床资料。记录治疗前、治疗后48h、治疗后72h供者血清淀粉酶和脂肪酶活性，观察治疗效果。以术中探查结果为金标准，计算测定血清淀粉酶、脂肪酶活性和超声检查的诊断阳性率。结果经乌司他丁和生长抑素联合使用持续3～7d后，32例供者的血清淀粉酶和血清脂肪酶活性均恢复正常，其中有4例血清淀粉酶和血清脂肪酶活性恢复正常，停药再次升高，继续使用上述治疗后在获取器官时均恢复到接近正常范围。器官获取术中探查结果示胰腺炎严重程度BalthazarCT形态评级A级1例，B级17例，C级9例，D级4例，E级1例。血清淀粉酶活性、血清脂肪酶活性和超声检查的诊断阳性率分别为66％（21／32）、78％（25／32）和56％（18／32）。结论供者进入捐献程序后应常规监测胰腺炎相关指标，血清脂肪酶活性的诊断阳性率较高，持续监测相关指标观察治疗效果，脑源性胰腺炎大部分程度较轻、治疗可逆。

Objective To observe the diagnosis and treatment of acute pancreatitis （AP） induced by the brain trauma and cerebral stroke in donors from donation after citizen death （DCD）, and maintenance of organ functions. Method The clinical data of 32 patients with different degrees of AP after brain trauma and cerebral stroke admitted by organ donation program between July 2011 and June 2015 were retrospectively analyzed. The donors with abdominal trauma and trauma after drinking were recruited. The serum amylase and lipase levels were increased in the first time, will be diagnosed as acute pancreatitis;Based on the original treatment, immediately given Ulinastatin, somatostatin and strengthen anti infection treatment; monitoring of serum amylase and lipase levels; color Doppler ultrasound examination of the pancreas; Identification of pancreatitis grading by careful investigation of the pancreatic appearances in organ procurement operation. Result 24 males and 8 females, aged from 16 to 57 years, Medianage 36 years. Cerebral stroke 13 cases, brain trauma 19 cases; Initial examination of serum amylase 440. 06 ± 144. 93 U/L （normal reference value ranges from 30 to 110 U/L）, serum lipase 1045.22 ± 103.20 U/L （normal reference value 20-300 U/L） ; Treatment after 72h, serum amylase 120. 78 ± 40. 34 U/L, serum tipase 279. 63 ± 103.20 U/L; Diagnostic accuracy of color Doppler ultrasound in acute pancreatitis was about 56%. Results from organ procurement operation.- 31 cases of acute pancreatitis, 1 cases of normal appearance. Conclusion After potential donor into the donation program, routinely monitoring of pancreatitis related blood index including serum amylase and serum lipase, early diagnosis and early treatment, continuous monitoring of Results of the index to observe the effect of treatment, The condition of acute pancreatitis-induced by the brain trauma and cerebral stroke donors is not serious, they will be reversible after treatment andreduce the damage for other organs to be donated.