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目的:探讨有心肺复苏史供者心脏死亡器官捐献(DCD)供肾肾移植围手术期诊疗方法及短期临床疗效。方法:回顾性分析2011年12月~2015年11月西安交通大学第一附属医院肾移植科完成的34例器官捐献前有心肺复苏史的供者,供给59例肾移植受者的供、受者临床资料,分析心肺复苏对DCD肾移植受者预后的影响。结果:有心肺复苏史DCD供肾肾移植受者术后短期内并发症发生率较高,早期人/肾存活率为84.74%,较无心肺复苏史DCD供者稍低但差异无统计学意义,长期人/肾存活率尚需进一步随访和观察。结论:1有心肺复苏史DCD供肾作为边缘性供肾,对器官短缺的现状是一种很好的补充;2供者纳入标准:<10min的心肺复苏、供者肾功正常,捐献器官可直接用于移植;10~30min的心肺复苏供者,需要严格观察血压、肾功能、尿量的综合变化,评估风险后考虑是否移植;心肺复苏>30min的供者尽量避免移植;3做好供体原发病全面准确评估和有效维护好器官功能,尤其加强Lifeport的应用及重视潜在感染供者(培养结果),并动态观察心肺复苏后尿量和肾功能的变化以及供体器官获取前激素、肝素、尿激酶的应用非常重要。
Objective: To investigate the perioperative diagnosis and treatment of short-term and long-term follow-up of renal allograft recipients with cardiac death organ donation (DCD) in the history of cardiopulmonary resuscitation. Methods: A retrospective analysis of 34 donors with history of cardiopulmonary resuscitation prior to organ donation from January 2011 to November 2015 in the Department of Kidney Transplantation, the First Affiliated Hospital of Xi’an Jiaotong University was conducted. The donor and recipient of 59 renal transplant recipients The clinical data, analysis of cardiopulmonary resuscitation on the prognosis of renal transplant recipients. Results: There was a high incidence of short-term complication after DCD for kidney transplant recipients with early history of cardiopulmonary resuscitation. The early human / kidney survival rate was 84.74%, which was slightly lower than that of no DCD donors with no history of cardiopulmonary resuscitation , Long-term human / kidney survival rate needs further follow-up and observation. Conclusions: 1 There is a history of cardiopulmonary resuscitation DCD for the kidneys as a marginal donor kidney, the status of organ shortage is a good supplement; 2 for the inclusion criteria: <10min cardiopulmonary resuscitation, donor renal function is normal, Directly for transplantation; 10 ~ 30min CPR donor, need to strictly observe the comprehensive changes in blood pressure, renal function, urine output, to assess whether the risk assessment after transplantation; CPR> 30min donor try to avoid transplantation; Comprehensive and accurate assessment of the primary disease and effective maintenance of organ function, especially to enhance the application of Lifeport and the potential infection donor (culture results), and dynamic observation of cardiopulmonary resuscitation urine output and renal function changes and donor organs to obtain pre-hormone , Heparin, urokinase application is very important.