北京市128例供肺评估、维护及获取情况分析

Evaluation,maintenance and procurement analysis of 128 lung donors from Beijing

目的:对2017年北京地区捐献供肺进行分析。方法:对128例供者的性别、年龄、血型、原发疾病、呼吸机支持时间、氧合指数、肺部影像学结果、气管镜结果等进行分析。结果:2017年,全国完成肺移植299例,供肺平均利用水平为5.82 %(299/5135)。北京地区2017年捐献肺脏463例,其中有128例达到了初步评估的标准,成功获取肺脏72例,占捐献总数的15.55 %。男性110例(85.94 %),女性18例(14.06 %),年龄(39.61±10.67)岁;机械通气时间(7.59±2.93) d。获取组氧合指数(450.37±67.79)mmHg,放弃组(338.49±116.15)mmHg( P=0.020)。获取组降钙素原中位数为0.195 ng/ml,放弃组为0.349 ng/ml( P=0.042)。 结论:氧合指数和降钙素原水平是决定供肺是否可以利用的独立影响因素。北京地区捐献供肺的前期维护相对成熟,供肺利用率高,值得在全国推广。

Objective To assess the potentials for lung donation among 128 donors(deceased citizens)in 2017 from Beijing.Methods Gender,age,blood type,duration of ventilation,oxygenation index(PaO2/FiO2),chest film and bronchoscopy were analyzed.Results A total of 5135 deceased Chinese citizens were available for donation in 2017.The rate of donation per million population(PMP)was 3.71.And 463 donors from Beijing were recorded in 2017 and the rate of PMP was 21.05.In 2017,299 lung transplantations were performed with an average rate of donor lung utility at 5.82%.Among 128 cases assessed for potential lung donors in Beijing,72 were successfully procured with a percentage of lung utilization of 15.55%.There were 110 males(85.94%)and 18 females(14.06%)with an average age of(39.61±10.67)years.Mechanical ventilation duration was(7.59±2.93)days.The oxygenation rate(PaO2/FiO2)was(397.38±105.01)mmHg,(450±67.79)mmHg in procurement group and(338.89±116.15)mmHg in non-procurement group(P=0.020).The median level of procalcitonin(PCT)was 0.195 ng/ml in procurement group versus 0.349 ng/ml in giving-up group(P=0.042).Conclusions Oxygenation rate and PCT level are the independent risk factors for reaching a procurement decision of donor lung.The actual PMP and lung procurement rate in Beijing were both higher than average domestic level(15.55%vs.5.82%,P=0.000)because of excellent cooperation between Organ Procurement Organization(OPO)and lung transplantation centers.The evaluation of donor lungs and lung maintenance protocols from Beijing should be popularized nationwide.