ECMO联合CRRT技术在脑死亡伴心肺功能不全供者器官功能维护中的应用

Applications of extracorporeal membrane oxygenation and continuous renal replacement therapy for maintaining organs of potential organ donors with cardiopulmonary failure after brain death

目的探讨体外膜肺氧合(ECMO)联合连续性肾脏替代治疗(CRRT)技术对于捐献前出现心肺功能不全的脑死亡器官捐献者肝功能的维护作用,提高边缘性捐献者肝的利用率。方法收集并分析2015年7月至2017年5月应用ECMO联合CRRT技术进行器官功能维护的5例心肺功能不全的脑死亡器官捐献者的临床资料及相应受者的临床资料。观察维护前后捐献者血压变化、血管活性药物使用剂量变化及肝、肾功能的变化以及尿量的改变情况,观察对应肝移植受者术后肝功能的恢复情况,并与18例非边缘性捐献者及接受其肝脏的受者术后肝脏功能恢复情况相比较。结果应用ECMO联合CRRT技术维护后,捐献者的血压由维护前血容量充足情况下大剂量升压药物也无法维持在高于90/60 mmHg达到100~140/60~90 mmHg,并且应用血管活性药物剂量明显减少,尿量较维护前上升。通过维护后4例捐献者肝脏可以使用,1例因总胆红素过高弃用。共获取4个肝脏,10个肾脏,对应的肝移植受者肝功能在术后与对照组受者无明显差异。结论应用ECMO联合CRRT技术可以改善伴有心肺功能不全的潜在捐献者供肝质量,提高器官捐献率和利用率。

Objective To explore the functions of extracorporeal membrane oxygenation (ECMO) with continuous renal replacement therapy (CRRT) for potential organ donors with cardiopulmonary failure after brain death and boost the coefficient of utilization of livers. Methods Analysis was conducted for clinical data of 5 donors with cardiopulmonary failure after brain death and their corresponding recipients from July 2015 to May 2017. Five donors received the treatments of ECMO and CRRT. The relevant data included changes of blood pressure, dosage of vasoactive agents, liver function, renal function and urine volume of those treated donors. Also liver functions of liver recipients were observed. Then the clinical data of 18 normal DBD and their liver recipients were compared. Results After ECMO/CRRT, donor blood pressures rose and the doses of vasoactive agents decreased. Meanwhile urine volume also increased. Finally 4/5 livers could be transplanted. And 10 kidneys were transplanted successfully. There was no significant inter-group difference of liver function. Conclusions The applications of ECMO and CRRT improve liver function of donors with cardiopulmonary failure after brain death and boost the rates of organ donation and utilization.