Riou B, Guesde R, Jacquens Y, Duranteau R, Viars P
Department of Anesthesiology and Critical Care, Groupe Hospitalier Pitié-Salpêtrière, Paris VI University, France.
Am J Respir Crit Care Med. 1994 Aug;150(2):558-60. doi: 10.1164/ajrccm.150.2.8049847.
Criteria for selecting lung donors include normal chest X-ray and adequate gas exchange, but normal bronchoscopy is not always required. Thus, we conducted a prospective study of fiberoptic bronchoscopy in 72 brain-dead donors scheduled for multiple organ procurement. Chest X-ray was considered normal in 37 donors (51%), and PaO2 was > 400 mm Hg with an FIO2 of 100% in 34 donors (47%). Fiberoptic bronchoscopy was normal in only 24 donors (33%). In the remaining 48 donors, inhalation of gastric contents (n = 26) or blood (n = 17), pulmonary contusion (n = 5), or purulent bronchial secretions (n = 4) were noted. In the 26 donors with normal chest X-ray and PaO2 > 400 mm Hg with FIO2 of 100%, bronchoscopy was abnormal in 10 donors (38%). In 33 donors, arteriovenous difference in oxygen content (2.4 +/- 0.8 ml O2/100 ml), and pulmonary shunt (0.30 +/- 0.11, range 0.13-0.49) were measured. In the 15 donors with PaO2 > 400 mm Hg, pulmonary shunt was 0.23 +/- 0.07 (range 0.13-0.35). Our study suggests that chest X-ray and arterial blood gas analysis are not sufficient, and that fiberoptic bronchoscopy should be routinely performed to select potential lung donors. Even in brain-dead donors, only the measurement of pulmonary shunt can precisely assess pulmonary gas exchange.
选择肺供体的标准包括胸部X线正常和气体交换充分，但并非总是需要支气管镜检查结果正常。因此，我们对72例计划进行多器官获取的脑死亡供体进行了纤维支气管镜检查的前瞻性研究。37例供体（51%）胸部X线被认为正常，34例供体（47%）在吸入氧分数为100%时动脉血氧分压>400 mmHg。仅24例供体（33%）纤维支气管镜检查结果正常。在其余48例供体中，发现有吸入胃内容物（n = 26）或血液（n = 17）、肺挫伤（n = 5）或脓性支气管分泌物（n = 4）。在胸部X线正常且吸入氧分数为100%时动脉血氧分压>400 mmHg的26例供体中，10例供体（38%）支气管镜检查结果异常。对33例供体测量了氧含量动静脉差值（2.4±0.8 ml O2/100 ml）和肺分流（0.30±0.11，范围0.13 - 0.49）。在动脉血氧分压>400 mmHg的15例供体中，肺分流为0.23±0.07（范围0.13 - 0.35）。我们的研究表明，胸部X线和动脉血气分析并不充分，应常规进行纤维支气管镜检查以选择潜在的肺供体。即使在脑死亡供体中，只有测量肺分流才能准确评估肺气体交换。
