263例公民逝世后器官捐献者的临床特点分析

Clinical characteristics analysis of 263 deceased organ donors

  • 摘要:
    目的  探讨重症监护室(ICU)内器官捐献者的临床特征,分析ICU综合治疗对器官功能维护及捐献效率的影响,为优化器官捐献管理策略提供数据支持。
    方法  回顾性分析2020年1月至2024年1月中山大学附属孙逸仙纪念医院ICU内263例经过积极治疗无效后进行器官捐献的捐献者资料,分析其临床特点、ICU内主要治疗措施及捐献器官情况。
    结果  263例器官捐献者外院住院时间2(1,5)d,本院住院为4(3,6)d,入院时慢性健康状况评分Ⅱ(APACHE Ⅱ)评分为(21±5)分。有心肺复苏史的器官捐献者占16.7%,有高血压病史的占30.4%,有颅脑手术史的占48.7%。ICU内给予肠内营养的时长为18(8,32)h,每日肠内营养提供能量160(0,320)kcal;肠外营养每日提供非蛋白热量877(710,1 058)kcal。每日纤维支气管镜检查0.25(0,0.50)次。90.1%进行了持续性肾脏替代治疗(CRRT),日均时间为10(6,16)h。每日人血白蛋白使用量为40(30,50)g,每日甲泼尼龙使用量为120(80,160)mg。最常用的经验性抗感染方案包括头孢哌酮舒巴坦59例(22.4%)、美罗培南联合万古霉素31例(11.8%)、哌拉西林他唑巴坦29例(11.0%)。最常用的目标导向抗感染调整方案为美罗培南联合万古霉素21例(8.0%)。经过ICU的综合治疗后,心功能、部分肝功能、部分凝血功能、肾功能、电解质及感染指标改善。263例器官捐献者共捐献器官981个,废弃器官23个,平均器官产出率为3.64,获取器官利用率为97.7%,各指标在纳入研究的4年间呈曲线增加。
    结论  ICU综合治疗显著改善了器官捐献者的心功能、部分肝功能、凝血功能及感染指标,提升了器官功能维护效果,为优化ICU内器官捐献管理和提高器官利用率提供了有效保障。

     

    Abstract:
    Objective To explore the clinical characteristics of organ donors in the intensive care unit (ICU), analyze the impact of comprehensive ICU treatment on organ function maintenance and donation efficiency, and provide data support for optimizing organ donation management strategies.
    Methods A retrospective analysis was conducted on the data of 263 donors who underwent organ donation after ineffective active treatment in the ICU of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2020 to January 2024. The clinical characteristics, main therapeutic measures in the ICU, and organ donation situations were analyzed.
    Results The 263 organ donors had an out-of-hospital hospitalization duration of 2 (1, 5) days and an in-hospital hospitalization duration of 4 (3, 6) days. The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score at admission was (21±5). Among them, 16.7% had a history of cardiopulmonary resuscitation, 30.4% had a history of hypertension, and 48.7% had a history of cranial surgery. The duration of enteral nutrition provided in the ICU was 18 (8, 32) hours, with daily energy provision of 160 (0, 320) kcal, parenteral nutrition provided non-protein energy of 877 (710, 1 058) kcal daily. Fiberoptic bronchoscopy was performed 0.25 (0, 0.50) times a day. Continuous renal replacement therapy (CRRT) was performed in 90.1% of the cases, with an average daily duration of 10 (6, 16) hours. The daily dosage of human albumin was 40 (30, 50) g, and the daily dosage of methylprednisolone was 120 (80, 160) mg. The most commonly used empirical anti-infection regimens included cefoperazone-sulbactam in 59 cases (22.4%), meropenem combined with vancomycin in 31 cases(11.8%), and piperacillin-tazobactam in 29 cases(11.0%). The most commonly used goal-directed anti-infection adjustment regimen was meropenem combined with vancomycin in 21 cases(8.0%). After comprehensive treatment in the ICU, cardiac function, some liver functions, some coagulation functions, renal function, electrolytes, and infection indicators improved. A total of 981 organs were donated by the 263 organ donors, with 23 organs discarded. The average organ yield rate was 3.64, and the organ utilization rate was 97.7%, with all indicators showing a curvilinear increase over the 4-year study period.
    Conclusions Comprehensive ICU treatment may significantly improve the cardiac function, some liver functions, coagulation functions, and infection indicators of organ donors, enhance the effect of organ function maintenance, and provide an effective guarantee for optimizing organ donation management in the ICU and improving organ utilization rates.

     

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