体外膜肺氧合技术对脑心双死亡器官捐献供肝的保护作用

目的探讨体外膜肺氧合(ECMO)技术在公民逝世器官捐献供肝保护中的应用,总结ECMO技术保护供肝的初步体会及经验。方法收集江西省人民医院2015年1月-2018年12月运用ECMO技术完成脑心双死亡器官捐献(DBCD)肝移植供者/受者及常规DBCD肝移植供者/受者的临床资料,对供肝的保护及移植效果进行对比分析。计量资料两组间比较采用t检验;计数资料两组间比较采用χ2检验。结果共纳入一般情况及肝功能接近的供者32例,根据采用的方法将其分为对照组(常规DBCD肝移植)和研究组(运用ECMO技术完成DBCD肝移植),每组各16例;32例肝移植受者分为对应的对照组(n=16)和研究组(n=16)。器官获取前供者对照组与供者研究组比较,心率、收缩压、舒张压、血氧分压、乳酸水平、中心静脉压、TBil、ALT、AST差异均有统计学意义(t值分别为14.121、-17.817、-19.187、-8.927、4.559、-3.495、3.357、4.111、3.553,P值均<0.05)。与受者对照组术后第7天肝功能相比,受者研究组肝移植术后肝功能恢复速度更快,两组TBil、DBil、ALT、AST、ALP、GGT比较,差异均有统计学意义(t值分别为9.309、4.783、5.067、2.203、4.774、5.257,P值均<0.05);受者研究组患者住院时间明显缩短[(12.65±2.86)d vs(20.87±4.98)d,t=5.756,P<0.001]。结论运用ECMO技术获取并实施肝移植临床效果较好,科学合理运用ECMO技术可以有效改善供肝质量,对我国公民逝世器官捐献工作有着积极的作用。

Clinical effect of extracorporeal membrane oxygenation in donor liver protection during donation after brain and cardiac death

Objective To investigate the application of extracorporeal membrane oxygenation(ECMO)in donor liver protection during donation after death,and to summarize the preliminary experience in the application of ECMO in donor liver protection.Methods Clinical data were collected from liver transplantation donors/recipients who received ECMO during donation after brain and cardiac death(DBCD)and those who received conventional DBCD liver transplantation,and a comparative analysis was performed for donor liver protection and outcome of transplantation.The t-test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups.Results A total of 32 donors with similar general status and liver function were enrolled and divided into control group(conventional DBCD liver transplantation)and experimental group(DBCD liver transplantation with ECMO),with 16 donors in each group.A total of 32 liver transplantation recipients were divided into corresponding control group and experimental group,with 16 recipients in each group.There were significant differences between the donor control group and the donor experimental group in heart rate,systolic pressure,diastolic pressure,partial pressure of blood oxygen,lactate level,central venous pressure,total bilirubin(TBil),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)(t=14.121,-17.817,-19.187,-8.927,4.559,-3.495,3.357,4.111,and 3.553,all P<0.05).Compared with the recipient control group on day 7 after surgery,the recipient experimental group had significantly faster recovery of liver function after liver transplantation using the ECMO technique,and there were significant differences between the two groups in TBil,DBil,ALT,AST,alkaline phosphatase,and gamma-glutamyl transpeptidase(t=9.309,4.783,5.067,2.203,4.774,and 5.257,all P<0.05).The recipient experimental group had a significantly shorter length of hospital stay than the recipient control group(20.87±4.98 d vs 12.65±2.86 d,t=5.756,P<0.001).Conclusion Liver transplantation using the ECMO technique has a good clinical effect,and scientific and rational use of ECMO can effectively improve the quality of donor liver.Therefore,it plays an active role in organ donation after Chinese citizen death.