Follette D M, Rudich S M, Babcock W D
Division of Transplantation, University of California, Davis, School of Medicine, Sacramento 95817, USA.
J Heart Lung Transplant. 1998 Apr;17(4):423-9.
The number of patients waiting lung transplantation greatly exceeds the supply of donors. This study was conducted to determine the effect of high-dose steroid administration on oxygenation and donor lung recovery after brain death.
A retrospective analysis was conducted on 118 consecutive organ donors from January 1 through December 31, 1995. Eighty donors received high-dose steroids (methylprednisolone, mean 14.5+/-0.06 mg/kg) after organ procurement organization management began; a second group was composed of 38 patients who received no steroids. PaO2/FiO2 ratios were used to evaluate oxygenation. The number of single and double lungs transplanted served as the endpoint.
No differences were noted in hemodynamics, most clinical or demographic variables and initial values of PaO2/FiO2 between groups. However, nonsteroid-treated donors showed an overall decrease in oxygenation (mean decrease in PaO2/FiO2 -34.2+/-14), whereas steroid-treated donors had a significant and progressive increase in oxygenation (mean increase in PaO2/FiO2: 16+/-14) before aortic cross-clamping (p = 0.01). Time before cross-clamping was longer in the steroid-treated patients (p = 0.003). The number of procured lungs was markedly greater in steroid-treated than nonsteroid-treated donors (25/80 patients vs 3/38; p < 0.01).
High-dose methylprednisolone given during donor management results in improved oxygenation at organ recovery. This treatment resulted in a significant increase in the number of lungs transplanted and may have enabled donors to be treated longer.
等待肺移植的患者数量远远超过供体的供应量。本研究旨在确定大剂量类固醇给药对脑死亡后氧合及供肺恢复的影响。
对1995年1月1日至12月31日连续118例器官供体进行回顾性分析。80例供体在器官获取组织管理开始后接受大剂量类固醇（甲泼尼龙，平均14.5±0.06mg/kg）；另一组由38例未接受类固醇治疗的患者组成。采用动脉血氧分压/吸入氧分数值（PaO2/FiO2）评估氧合情况。移植单肺和双肺的数量作为终点指标。
两组之间在血流动力学、大多数临床或人口统计学变量以及PaO2/FiO2的初始值方面未发现差异。然而，未接受类固醇治疗的供体氧合情况总体下降（PaO2/FiO2平均下降-34.2±14），而接受类固醇治疗的供体在主动脉阻断前氧合情况显著且持续改善（PaO2/FiO2平均升高：16±14）（p=0.01）。接受类固醇治疗的患者在主动脉阻断前的时间更长（p=0.003）。接受类固醇治疗的供体获取的肺数量明显多于未接受类固醇治疗的供体（80例患者中有25例，38例患者中有3例；p<0.01）。
在供体管理期间给予大剂量甲泼尼龙可改善器官恢复时的氧合情况。这种治疗使移植的肺数量显著增加，并且可能使供体的治疗时间延长。
