颅内出血心脑死亡器官捐献供体的安全性评估(1)
摘 要：随着器官移植技术的发展，肾移植成为治疗终末期肾病的最有效方法，与透析相比，肾移植受者预期寿命得到延长，生活质量显著提高，总的治疗费用基本持平。然而，器官供应短缺是肾移植的主要障碍，等待移植的患者以及等待中死亡的患者人数却逐年增加，当今心脑死亡供体的器官捐献是我国肾移植的主要来源，扩大标准供体的使用已被提上日程以扩大供体池。实践中，颅内出血导致患者心、脑死亡所占比例大，成为供体器官最重要来源。但是，颅内出血病因众多，因供体评估时间、评估手段、评估经验欠缺等原因，存在供体既存的其他病理性因素未被发现或者认识不足，例如供肾质量差，隐匿的肿瘤性病变等情况。一旦将此类供肾移植给受着，则会带来肿瘤的复发、移植肾功能丧失、甚至危及受体生命的严重后果。反之因过度担心术后并发症，可能将符合标准的移植物弃用，而导致器官的浪费现象。因此通过文献回顾，总结国内外有颅内出血病史供体器官的使用经验和原则。
关键词：肾移植；评估；颅内出血
中图分类号：R699.2 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.07.018
, http://www.100md.com
文章编号：1006-1959(2018)07-0053-05
Evaluation of the Safety of Intracranial Hemorrhage Donors for Organ Donation
LI Mao，KANG Jian，LIANG Si-min
(Department of Urology，The First Affiliated Hospital，Chongqing Medical University，Chongqing 400016，China)
Abstract：With the development of organ transplantation，kidney transplantation has become the most effective method for the treatment of end-stage renal disease，compared with dialysis，renal transplant recipients are expected to prolong service life，quality of life improved significantly，the total treatment cost roughly the same.However，the organ shortage is a major obstacle to renal transplantation，patients waiting for transplantation and the number of patients waiting for death is increasing year by year，the brain dead donor organ donation is the main source of kidney transplantation in China，using the expanded criteria donor has been put on the agenda in order to expand the donor pool.In practice，intracranial hemorrhage in patients with heart，brain death proportion，become the most important source of donor organs.However，because of the multitude of intracranial hemorrhage，due to the donor evaluation time， assessment methods，assessment of the lack of experience and other reasons，the donor of other pathological factors existing undetected or lack of knowledge，such as the poor quality of donor kidney tumors，such as hidden.Once the kidney transplant is received，it will bring about the recurrence of the tumor，the loss of renal function，and even the serious consequences of the life of the recipient.On the other hand，excessive fear of postoperative complications may lead to a standard discarding of the grafts that lead to the waste of the organs.Therefore，through literature review，summarizes the experience and history of the principle of intracranial hemorrhage of donor organs at home and abroad.
, 百拇医药
Key words：Renal transplantation；Evaluation；Intracranial hemorrhage
顱内出血的原因众多，目前对其病因分型没有统一标准，有学者将其分为原发性颅内出血和继发性颅内出血两大类。高血压病、淀粉样血管病等导致小动脉、小穿支动脉的破裂，造成原发性颅内出血，占颅内出血类型的85%。血管畸形、肿瘤、血液系统疾病、凝血障碍、药物因素、脑梗死、脑部炎症等所致的颅内出血，为继发性颅内出血，约占15%。有文献[1]统计出各类病因所占比例，分别为高血压病(36.81%)、原因不明(33.61%)、脑淀粉样血管病(14.59%)、脑血管结构病变(10.59%)、药物因素(2.76%)、全身性疾病(1.64%)等六类。, 百拇医药(李茂 康简 梁思敏)
关键词：肾移植；评估；颅内出血
中图分类号：R699.2 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.07.018
, http://www.100md.com
文章编号：1006-1959(2018)07-0053-05
Evaluation of the Safety of Intracranial Hemorrhage Donors for Organ Donation
LI Mao，KANG Jian，LIANG Si-min
(Department of Urology，The First Affiliated Hospital，Chongqing Medical University，Chongqing 400016，China)
Abstract：With the development of organ transplantation，kidney transplantation has become the most effective method for the treatment of end-stage renal disease，compared with dialysis，renal transplant recipients are expected to prolong service life，quality of life improved significantly，the total treatment cost roughly the same.However，the organ shortage is a major obstacle to renal transplantation，patients waiting for transplantation and the number of patients waiting for death is increasing year by year，the brain dead donor organ donation is the main source of kidney transplantation in China，using the expanded criteria donor has been put on the agenda in order to expand the donor pool.In practice，intracranial hemorrhage in patients with heart，brain death proportion，become the most important source of donor organs.However，because of the multitude of intracranial hemorrhage，due to the donor evaluation time， assessment methods，assessment of the lack of experience and other reasons，the donor of other pathological factors existing undetected or lack of knowledge，such as the poor quality of donor kidney tumors，such as hidden.Once the kidney transplant is received，it will bring about the recurrence of the tumor，the loss of renal function，and even the serious consequences of the life of the recipient.On the other hand，excessive fear of postoperative complications may lead to a standard discarding of the grafts that lead to the waste of the organs.Therefore，through literature review，summarizes the experience and history of the principle of intracranial hemorrhage of donor organs at home and abroad.
, 百拇医药
Key words：Renal transplantation；Evaluation；Intracranial hemorrhage
顱内出血的原因众多，目前对其病因分型没有统一标准，有学者将其分为原发性颅内出血和继发性颅内出血两大类。高血压病、淀粉样血管病等导致小动脉、小穿支动脉的破裂，造成原发性颅内出血，占颅内出血类型的85%。血管畸形、肿瘤、血液系统疾病、凝血障碍、药物因素、脑梗死、脑部炎症等所致的颅内出血，为继发性颅内出血，约占15%。有文献[1]统计出各类病因所占比例，分别为高血压病(36.81%)、原因不明(33.61%)、脑淀粉样血管病(14.59%)、脑血管结构病变(10.59%)、药物因素(2.76%)、全身性疾病(1.64%)等六类。, 百拇医药(李茂 康简 梁思敏)