ICU management of organ donor

doi:10.3877/cma.j.issn.2096-1537.2017.02.002

Abstract

Abstract:

Organ transplantation is the best way to improve survival and quality of life in patients with end-stage organ failure. The shortage of organs has become a serious health-care issue and social problem. Early identification of potential organ donor and goal-directed management in intensive care unit can increase the rate of donate organ harvesting and improve organ function.

Key words: Organ transplantation, Donor, Management, Intensive care units

Yanping Zhu, Changjie Cai, Xiangdong Guan. ICU management of organ donor[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2017, 03(02): 85-90.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2017.02.002

https://icu.cma-cmc.com.cn/EN/Y2017/V03/I02/85

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References 47

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Maastricht分类	描述	特点
Ⅰ	入院前已经宣告死亡，不可能复苏	少用（主要西班牙和法国）
Ⅱ	复苏失败：院外心脏停搏和院内难治性心脏停搏	少用（主要西班牙和法国）
Ⅲ	受到严重的不可救治性损伤或住院患者有计划撤除生命支持	最常用，撤除生命支持到心跳停止时间是器官能否获取的主要决定因素
Ⅳ	BD评估期间或确认后、器官获取前出现心跳骤停	不常见，根据复苏结果选择DBD或DCD流程
Ⅴ	医疗支持下，疾病末期患者心跳呼吸停止	作为安乐死组成部分，绝大多数国家不认可

Maastricht分类	描述	特点
Ⅰ	入院前已经宣告死亡，不可能复苏	少用（主要西班牙和法国）
Ⅱ	复苏失败：院外心脏停搏和院内难治性心脏停搏	少用（主要西班牙和法国）
Ⅲ	受到严重的不可救治性损伤或住院患者有计划撤除生命支持	最常用，撤除生命支持到心跳停止时间是器官能否获取的主要决定因素
Ⅳ	BD评估期间或确认后、器官获取前出现心跳骤停	不常见，根据复苏结果选择DBD或DCD流程
Ⅴ	医疗支持下，疾病末期患者心跳呼吸停止	作为安乐死组成部分，绝大多数国家不认可

系统	监测和管理
心血管	有创心血管监测维持等血容量目标MAP≥60~70 mmHg，没有证据显示某一升压药/正性肌力药优于其他，血管加压素可作为一线选择，AVP用量0.01~0.04 IU/min，减少儿茶酚胺用量尽量避免大剂量去甲肾上腺素[0.5 μg/（kg?min）]，难治性低血压可以考虑使用甲状腺激素
呼吸	保护性肺通气：潮气量6~8 ml/kg，PEEP 6~8 cmH₂O PaO₂≥80 mmHg，PaCO₂ 35~45 mmHg，pH 7.35~7.45必要时实施肺复张手法，实施包括抬高床头在内的集束化护理
液体和电解质	维持等血容量，避免高钠血症，尿量0.5~2.5 ml/（kg?h）尿量>4 ml/（kg?h）时，考虑尿崩症，使用血管加压素或去氨加压素使用胰岛素输注维持血糖<10 mmol/L
激素替代治疗	高钠血症的尿崩症，去氨加压素首次1~4 μg静脉注射，后根据尿量、渗透压和血钠，每6 h加用1~2 μg或更高剂量血流动力学不稳定的高钠血症患者，可同时使用AVP和去氨加压素脑死亡确认后甲强龙15 mg/kg静脉推注，随后每日应用T3和T4用于甲状腺激素替代治疗，T3 4 μg静脉注射，随后3 μg/h静脉输注；或者T4 20μg静脉注射，随后10 μg/h静脉输注
血液和凝血	纠正凝血病，Hb<70 g/L时输注浓缩红细胞，持续预防血栓治疗
体温	减少热量散失，维持中心温度35℃，吸入气体湿化加温静脉输注液治疗感染

系统	监测和管理
心血管	有创心血管监测维持等血容量目标MAP≥60~70 mmHg，没有证据显示某一升压药/正性肌力药优于其他，血管加压素可作为一线选择，AVP用量0.01~0.04 IU/min，减少儿茶酚胺用量尽量避免大剂量去甲肾上腺素[0.5 μg/（kg?min）]，难治性低血压可以考虑使用甲状腺激素
呼吸	保护性肺通气：潮气量6~8 ml/kg，PEEP 6~8 cmH₂O PaO₂≥80 mmHg，PaCO₂ 35~45 mmHg，pH 7.35~7.45必要时实施肺复张手法，实施包括抬高床头在内的集束化护理
液体和电解质	维持等血容量，避免高钠血症，尿量0.5~2.5 ml/（kg?h）尿量>4 ml/（kg?h）时，考虑尿崩症，使用血管加压素或去氨加压素使用胰岛素输注维持血糖<10 mmol/L
激素替代治疗	高钠血症的尿崩症，去氨加压素首次1~4 μg静脉注射，后根据尿量、渗透压和血钠，每6 h加用1~2 μg或更高剂量血流动力学不稳定的高钠血症患者，可同时使用AVP和去氨加压素脑死亡确认后甲强龙15 mg/kg静脉推注，随后每日应用T3和T4用于甲状腺激素替代治疗，T3 4 μg静脉注射，随后3 μg/h静脉输注；或者T4 20μg静脉注射，随后10 μg/h静脉输注
血液和凝血	纠正凝血病，Hb<70 g/L时输注浓缩红细胞，持续预防血栓治疗
体温	减少热量散失，维持中心温度35℃，吸入气体湿化加温静脉输注液治疗感染

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