徒手-机器联合复苏在脑死亡供者心脏骤停后器官维护中的作用

Role of manual and mechanical chest compression in organ maintenance after cardiac arrest of brain-dead donors

目的探讨徒手-机器联合复苏在脑死亡器官捐献(DBD)供者心脏骤停后器官维护中的价值。方法回顾性分析2020年1月6日至2020年2月20日在广州中医药大学第二附属医院采用徒手-机器联合复苏的3例DBD供者及对应6例受者临床资料。患者均签署知情同意书,符合医学伦理学规定。供者均为男性,年龄分别为44、52、57岁。死亡原因为脑干出血、脑外伤、脑梗死。依据脑死亡判定标准与技术规范进行评估,符合中国Ⅰ类器官捐献。3例供者突发心脏骤停时即刻予徒手心肺复苏并进行全身肝素化,给予肾上腺素、阿托品等抢救药物,安装胸腔按压机接力复苏。总结供体维护方案及心脏骤停复苏方法,观察供、受者围手术期情况及术后并发症情况等。结果1例因供肝脂肪变性程度约60%且为大泡性脂肪变性而弃用,余2例肝脏均成功完成移植;1例供者的2个肾脏因微循环严重血栓而弃用,余4个肾脏均成功完成移植。徒手、机器交替时间间隔约1 min,联合复苏时间中位数为68(65~78)min,热缺血时间7(5~8)min,冷缺血时间6.8(4.5~11.0)h。2例肝移植受者术后肝功能恢复良好,未发生并发症。肾移植受者1例术后第7天发生急性排斥反应,给予抗排斥治疗后肾功能恢复正常,术后4个月出现移植肾动脉狭窄,予加用抗血小板聚集及降脂药物治疗后狭窄减轻,移植肾功能恢复正常;1例发生移植肾功能延迟恢复,给予血液透析辅助治疗后恢复正常;余2例术后恢复顺利,未发生并发症。结论徒手-机器联合复苏能维持DBD供者心脏骤停后的生命体征,保证肝脏、肾脏的血液灌注,提高捐献成功率和器官利用率。

Objective To assess the value of manual and mechanical chest compression in organ maintenance after cardiac arrest of brain-dead donors(DBD).Methods Clinical data of 3 DBD donors and 6 recipients who received manual and mechanical chest compression in the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from January 6 to February 20,2020 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.All donors were male,aged 44,52 and 57 years,respectively.The causes of death were brain stem hemorrhage,brain trauma and cerebral infarction.According to the assessment criteria and technical specifications of brain death,all donors were in accordance with China's CategoryⅠorgan donation.Manual chest compression and systemic heparinization were immediately performed after sudden cardiac arrest in 3 donors,and adrenaline,atropine were used,chest press machine was installed for relay resuscitation.The donor maintenance regimens and resuscitation methods of cardiac arrest were summarized.Perioperative conditions of donors and recipients and postoperative complications were observed.Results 1 donor liver was discarded due to 60%steatosis and mainly macrovesicular steatosis,and the liver transplantations of remaining 2 donor livers were successfully performed.2 kidneys of one donor were discarded due to severe microcirculatory thrombosis,and the other 4 kidneys were successfully transplanted.The time interval between manual and mechanical chest compressions was approximately 1 min,the median combined resuscitation time was 68(65-78)min,the warm ischemia time was 7(5-8)min,and the cold ischemia time was 6.8(4.5-11.0)h.Liver function of 2 liver transplant recipients recovered well without complications.Acute rejection occurred in one renal transplant recipient at postoperative 7 d,and renal function was restored to normal after anti-rejection treatment.At postoperative 4 months,renal arterial stenosis occurred,which was alleviated after anti-platelet aggregation and lipid-lowering drug treatment and renal function was restored to normal.Delayed graft function occurred in 1 case,which was restored to normal after hemodialysis.The other 2 cases recovered smoothly without complications.Conclusions Manual and mechanical chest compressions can maintain vital signs of DBD donors after cardiac arrest,guarantee the blood perfusion of liver and kidney,and enhance the success rate of organ donation and organ utilization rate.