器官捐献者转介时的临床特征分析

Analysis of clinical characteristics of organ donors at referral

目的分析器官捐献者转介时的临床特征变化,为器官捐献者临床管理策略的优化提供依据。方法回顾性分析2016至2019年中山大学附属第三医院器官获取组织完成的218例器官捐献者临床资料。比较不同年份器官捐献者转介时留置静脉管路情况、病原体携带情况,以及血红蛋白、血白蛋白和血钠等内环境指标,采用血管活性药物评分(VIS)评估捐献者血管活性药物使用情况。比较转介时留置不同静脉管路的器官捐献者VIS。结果218例器官捐献者中,男性185例,女性33例,平均年龄(42±15)岁。2016至2019年分别完成35、48、50和85例公民逝世后器官捐献。不同年份器官捐献者性别、年龄和血型等构成差异均无统计学意义(P均>0.05)。218例器官捐献者转介时均留置静脉管路并不同程度地使用血管活性药物,留置上腔静脉导管、下腔静脉导管和外周静脉导管的捐献者分别为149、29和40例。2016至2019年上腔静脉导管使用率分别为48.6%、68.8%、58.0%和82.4%,VIS分别为(74±49)、(51±43)、(65±57)和(49±44)分,差异均有统计学意义(χ^(2)/F=29.65、2.90,P均<0.05)。上腔静脉导管组VIS为(34±27)分,低于下腔静脉导管组和外周静脉导管组[(110±50)和(105±45)分],差异有统计学意义(P均<0.05)。器官捐献者转介时痰液标本病原体培养阳性率最高,不同年份差异有统计学意义(χ^(2)=62.52,P<0.05)。器官捐献者转介时血红蛋白、血白蛋白和血钠均处于异常水平,不同年份差异均无统计学意义(P均>0.05)。结论器官捐献者转介前的临床管理仍需继续完善,除电解质紊乱、贫血和低蛋白血症外,静脉通道的选择和感染防控需得到更多关注。

Objective To analyze the changes of clinical characteristics of organ donors at the time of referral,and to provide evidence for optimizing the clinical management strategies of organ donors.Methods The clinical data of 218 organ donors from the Third Affiliated Hospital of Sun Yat-sen University from 2016 to 2019 were analyzed retrospectively.Indwelling venous catheter,pathogen infection,and internal environment parameters such as hemoglobin,serum albumin and serum sodium were compared during organ donor referral in different years,and vasoactive drug use in donors was assessed using the vasoactive-inotropic score(VIS).Compared the VIS of organ donors with different intravenous catheter at the time of referral.Results Of the 218 organ donors,185 were male and 33 were female,with an average age of(42±15)years.Thirty-five,48,50 and 85 cases of organ donation after citizen′s death were completed from 2016 to 2019,respectively.There were no significant differences in sex,age and blood group composition of organ donors in different years(P>0.05 for all).The use rates of superior vena cava catheters from 2016 to 2019 were 48.6%,68.8%,58.0%and 82.4%,respectively,and the difference was statistically significant(χ^(2)=29.65,P<0.05).From 2016 to 2019,the VIS of organ donors at referral was(74±49),(51±43),(65±57)and(49±44)points,respectively,and the difference was statistically significant(F=2.90,P<0.05);among them,the VIS of the superior vena cava catheter group was(34±27)points,which was lower than that of the inferior vena cava catheter group and the peripheral vena cava catheter group[(110±50)and(105±45)points],and the difference was statistically significant(P<0.05 for all).The positive rate of pathogen culture in sputum samples was the highest,and the difference was statistically significant in different years(χ^(2)=62.52,P<0.05).Hemoglobin,serum albumin and serum sodium were at abnormal levels during organ donor referral,and there were no significant differences in different years(P>0.05 for all).Conclusions The clinical management of organ donors before referral still needs to be improved.In addition to electrolyte imbalance,anemia and hypoproteinemia,the selection of venous access and infection prevention and control need to be paid more attention.