体外膜肺氧合减轻脑死亡后循环功能不稳定供肾损伤的研究

Extracorporeal membrane oxygenation alleviating kidney damage caused by unstable circulation function following brain deaths

目的 通过对体外膜肺氧合（ECMO）减轻循环功能不稳定的国际标准化脑死亡器官捐赠（DBD）供肾损伤的研究,以提高DBD供肾的利用率.方法 随机选取60例循环功能不稳定的DBD患者,按ECMO体内灌注的时间随机分为3组,第1组利用ECMO灌注2h,第2组利用ECMO灌注4h,第3组利用ECMO灌注6h.同时随机选取20例循环功能稳定的DBD作为对照组.比较肾移植术后的原发性移植肾无功能发生率、移植肾功能延迟恢复发生率、急性排斥反应发生率、肾功能恢复时间、术后第1天尿量、术后1年肌酐及术后1年的尿素氮.结果第1组、第2组、第3组及对照组的移植肾功能延迟恢复发生率分别为10％（2/20）、15％ （3/20）、5％（1/20）及10％（2/20）.第1组、第2组、第3组及对照组的急性排斥反应发生率分别为30％（6/20）、25％ （5/20）、35％（7/20）及25％ （5/20）.原发性移植肾无功能发生率、移植肾功能延迟恢复发生率及急性排斥反应发生率3个指标在第1组、第2组和第3组与对照组比较,差异均无统计学意义（P＞0.05）.第1组、第2组、第3组及对照组的平均肾功能恢复时间分别为（9.6±2.0）d、（9.7±2.7）d、（9.5±1.9）d及（7.3±3.1）d.第1组、第2组、第3组及对照组的术后第1天平均尿量分别为（3405±755） ml、（3300±600） ml、（3810±825） ml及（3600±780 ml）.第1组、第2组、第3组及对照组的术后1年平均肌酐分别为（92±28） μmol/L、（101±31） μmol/L、（98±30） μmol/L及（95±30） μmol/L.第1组、第2组、第3组及对照组的术后1年平均尿素氮是（4.2±2.2） mmol/L、（5.6±2.6）mmol/L、（5.2±2.6）mmol/L及（5.5±2.5）mmol/L.与对照组比较,第1组、第2组、第3组的肾功能恢复时间长（P＜0.05）,但第1组、第2组、第3组之间肾功能恢复时间并无明显差别（P＞0.05）.术后第1天的尿量、移植后1年的肾功能在第1组、第2组、第3组与对照组之间均无统计学差异（P＞0.05）.EMCO辅助的循环功能不稳定的DBD组只有术后肾功能恢复时间略长于循环功能稳定的DBD组,而其他各项指标均比较,差异无统计学意义.结论 利用ECMO辅助循环功能不稳定的DBD可以较好的保护供肾功能,扩大供者器官使用率.

Objective Through studying the extracorporeal membrane oxygenation （ECMO）alleviating kidney damage caused by unstable circulation function following brain deaths to improve the utilization rate of donation after brain death （DBD） for renal transplantation.Methods Randomly selected 60 DBD patients with unstable circulatory function were randomly divided into 3 groups according to the time of perfusion by ECMO.The first group used ECMO perfusion for 2 h,group 24 h and group 36 h.At the same time,20 cases of stable DBD were randomly selected as the control group.The incidence of primary graft failure,delayed graft function and acute rejection,renal function recovery time,urine volume on the first day after surgery,creatinine and urea nitrogen one year after surgery were compared between two groups.Results The incidence of delayed recovery of renal function in experimental groups 1,2,3 and control group was 10% （2/20）,15% （3/20）,5%（1/20） and 10% （2/20） respectively.The incidence of acute rejection in experimental groups 1,2,3 and control group was 30% （6/20）,25% （5/20）,35% （7/20） and 25% （5/20） respectively.There were no statistically significant differences between the experimental groups and the control group （P 〉0.05）.The mean renal function recovery time in the experimental groups 1,2,3 and control group was （9.6 ± 2.0）,（9.7 ± 2.7）,（9.5 ± 1.9） and （7.3 ± 3.1） days respectively.The average urine volume in experimental groups 1,2,3 and control group was （3 405 ± 755）,（3 300 ±600）,（3 810±825）,and （3 600 ± 80） mL respectively.In experimental groups 1,2,3 and control group,the average creatinine level was （92 ± 28）,（92 ± 28）,（101 ± 31）,and （98 ± 30） μmol/L respectively.The average urea nitrogen in experimental groups 1,2,3 and control group was （4.2 ± 2.2）,（5.6 ± 2.6）,（5.2 ± 2.6） and （5.5 ± 2.5） mmol/L respectively.The recovery time of renal function in the experimental groups was longer than that in the control group （P〈0.05）,but there was no significant difference among the experimental groups （P〉0.05）.There was no statistically significant difference between the experimental groups and the control group in urine volume one day after surgery and kidney function one year after transplantation （P〉0.05）.Only recovery time after operation of the DBD with the unstable circulation function assisted by EMCO was slightly longer than that with stable circulation function,while the rest indexes showed no statistically significant difference.Conclusion DBD with unstable circulation function with ECMO auxiliary circulatory function can protect the renal function and increase the utilization rate of donor organs.