發(fā)布時(shí)間：2018-03-17 08:28

  本文選題：腦死亡器官捐獻(xiàn)　切入點(diǎn)：心臟移植　出處：《山東大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：分析總結(jié)山東省心臟移植中心腦死亡器官捐獻(xiàn)(donation after brain death, DBD)心臟移植的可行性、療效和經(jīng)驗(yàn)。研究方法：回顧性分析2014年8月至2016年3月,本中心連續(xù)實(shí)施的14例DBD心臟移植病例。對(duì)收集的供、受者臨床資料及受者術(shù)后恢復(fù)情況進(jìn)行匯總、分析。所有捐獻(xiàn)器官的獲取和移植過(guò)程均符合國(guó)家規(guī)定。結(jié)果：14例DBD供體(男／女=12：2,平均年齡33.7歲)主要死因?yàn)轱B腦損傷(9/14例)、腦血管意外(2/14例)、缺氧(1/14例)、中樞腫瘤(1/14例)、腹部外傷(1/14例),其中邊緣供心3例。14例DBD心臟移植受者(男／女=9：5,平均年齡52.8歲)主要診斷為心肌病(10/14例)、冠心病(3/14例)、瓣膜病(1/14例)。移植術(shù)后,除了痰或尿培養(yǎng)陽(yáng)性事件外,1例受者移植后出現(xiàn)原發(fā)性移植物功能衰竭,給予“主動(dòng)脈內(nèi)球囊反搏聯(lián)合體外膜肺氧合”機(jī)械輔助治療,術(shù)后第二天出現(xiàn)遲發(fā)性心包填塞,二次開(kāi)胸治療痊愈,術(shù)后1個(gè)月行胸部CT檢查發(fā)現(xiàn)Standford B型主動(dòng)脈夾層,行主動(dòng)脈腔內(nèi)隔絕術(shù)治療；1例發(fā)生氣胸,立即行閉式胸腔引流；1例術(shù)后早期急性腎功能不全,行血液透析治療三天,腎功能恢復(fù)正常；1例術(shù)前應(yīng)用呼吸機(jī)輔助通氣治療患者,術(shù)后出現(xiàn)氣管狹窄,兩次于我院行纖支鏡下肉芽組織電灼治療,效果差,于外院行氣管支架植入術(shù)。所有患者術(shù)后均根據(jù)原位雜交基因檢測(cè)結(jié)果確定免疫抑制劑起始劑量及用藥方案,通過(guò)監(jiān)測(cè)血藥濃度谷、峰值,調(diào)整用藥劑量,無(wú)急性排斥反應(yīng)發(fā)生。14例受者全部痊愈出院,現(xiàn)已恢復(fù)正常工作,生活質(zhì)量良好,受者術(shù)后平均隨訪時(shí)間11.1個(gè)月(3-19個(gè)月),1個(gè)月及3個(gè)月生存率均為100%。結(jié)論：經(jīng)嚴(yán)格篩選的DBD供心可用于心臟移植,且能取得良好的臨床效果。DBD是解決我國(guó)當(dāng)前心臟移植供心短缺的有效途徑。術(shù)前及術(shù)后盡早積極地采用機(jī)械輔助支持,將有助于延長(zhǎng)受體等待時(shí)間、促進(jìn)移植者心功能恢復(fù),大幅度改善患者預(yù)后。采用原位雜交基因檢測(cè)等方法,有助于個(gè)體化用藥,提高患者生存質(zhì)量。
[Abstract]:Objective: to analyze the feasibility, curative effect and experience of brain death organ donation after brain death (DBD) in Shandong Heart Transplantation Center. Methods: from August 2014 to March 2016, a retrospective study was conducted. There were 14 consecutive cases of DBD heart transplantation performed in our center. The donors, the clinical data of the recipients and the postoperative recovery of the recipients were summarized. All donor organs were obtained and transplanted according to state regulations. Results: 14 DBD donors (male / female 12: 2, mean age 33.7 years) died mainly from craniocerebral injury in 9 / 14 cases, cerebrovascular accident in 2 / 14 cases, hypoxia in 1 / 14 cases, anoxia in 14 cases. There were 14 cases of armature tumor, 14 cases of abdominal trauma and 14 cases of abdominal trauma. Among them, 3 cases of marginal donor heart, 14 cases of DBD heart transplant recipients (male / female 9: 5, mean age 52.8 years) were mainly diagnosed as 10 / 14 cases of cardiomyopathy, 3 / 14 cases of coronary heart disease, 14 cases of valvular disease and 1 / 14 cases of valvular disease. In addition to sputum or urine culture positive events, one recipient developed primary graft failure after transplantation. He was treated with mechanical adjuvant therapy of "intraaortic balloon counterpulsation combined with external membrane pulmonary oxygenation", and delayed pericardial tamponade appeared on the second day after operation. The second thoracotomy was cured, the Standford B aortic dissection was found by CT examination 1 month after operation, the pneumothorax occurred in 1 case by endovascular exclusion of aorta, and the acute renal insufficiency was found in 1 case immediately by closed thoracic drainage. After three days of hemodialysis treatment, one patient with normal renal function was treated with ventilator assisted ventilation before operation. He developed trachea stenosis after operation, and was treated with cauterization of granulation tissue under fiberoptic bronchoscope, and the effect was not good. All patients were treated with tracheal stent implantation in our hospital. According to in situ hybridization gene test results, the initial dose of immunosuppressant and the drug regimen were determined, and the dosage was adjusted by monitoring blood concentration valley, peak value, and adjusting dosage. No acute rejection occurred. All of the 14 patients were cured and discharged from hospital, and now they have returned to normal work, and the quality of life is good. The mean follow-up time was 11.1 months to 19 months. The survival rate of 1 and 3 months was 100. Conclusion: DBD donor heart can be used for cardiac transplantation. DBD is an effective way to solve the shortage of donor heart in our country. Using mechanical support as early as possible before and after operation will help to prolong the waiting time of the recipient and promote the cardiac function recovery. The method of in situ hybridization gene detection is helpful for individualized drug use and the improvement of patients' quality of life.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R654.2

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