=目的>调查在试点城市之一一天津市开展心脏死亡器官捐献(donation afte:cardiacdeath,DCD)的可行性,为进行全市医院调查!在天津市建立潜在 供体库提供具体数据支持 =方法>(l)回顾性分析天津市第一中心医院2007~2009年住院死亡病例, 以5国际疾病分类6ICD一10疾病分类原则为依据,分析病因构成(2)分析总 结2007~2009年天津市第一中心医院车祸外伤等意外死亡以及脑血管意外死亡 病例,分析一般资料!重要脏器功能状态,从临床技术层面进行潜在DCD的评 估(3)以调查问卷形式对车祸外伤!脑血管意外患者家属进行调查,主要内 容包括对器官移植的认识,对个人及患病亲属捐献器官的态度!意愿 =结果>(l)天津市第一中心医院2007~2009年2702例住院死亡病例死因 分析,因肿瘤死亡人数最多,占全部死亡构成的24.犯%,其它依次为呼吸系统 疾病(20.犯%)!循环系统疾病(18.84%)!损伤和中毒(9.88%)以及神经系统 疾病(9.84%);因损伤!中毒等意外死亡人数共计267人,主要发生在巧~44岁 青壮年组(占48.69%)主要原因是车祸造成的各类外伤(占65.92%)(2)综 合评估127例车祸外伤!脑血管意外死亡病例其中117例符合临床捐献肝!肾条 件,占三年住院死亡病人总例数的4.33%(3)对车祸外伤!损伤中毒以及脑 血管意外患者家属的调查,大部分人(51.33%)对器官移植法规仅听说过,33.33% 的人表示个人有捐献意愿,而在决定患病亲人的器官捐献问题时,21.33%家属 表示不同意,多数家属(42.00%)表示会同其他家属商量后再作决定 I结论>加强死因顺位前五位疾病的防治工作,降低病死率,提高生命质 量;医务工作者在接诊!治疗危重病患者时尽可能完善各类检查,维持潜在DCD 供体血流动力学及内分泌功能等内环境稳定,以利于提高潜在供者的数量;公 众对器官捐献的了解和认识还有很多空缺,相关部门应通过各种途径加大社会 宣传的力度和广度,广泛开展与器官捐献相关的公民教育,将器官捐献的正面 意义渗透到学校教育中去,让人们逐渐认识到器官捐献的重要意义,充分挖掘 潜在志愿者 关键词:住院死亡病因构成器官移植心脏死亡器官捐献公民教育天津医科大学硕士学位报告 Abstr8Ct [objectivelTosurveythefeasibilityofdevelopingdonationaftercardiaedeath (DCD)inTianjin,oneoftheseleetedexPerimenialeities.Thenbasedonthat,to ProvideeoneretedatasuPPortforearryingoutinvestigationonhosPitalsthroughout thecityandestablishingthePoteniialdonorPoolforDCD. [Methodsl(1)ThediseaseseonstituteofinPatientdeatheasesinTianjinFirst CenierHosPitalbetween2007and2009,wasanalysedbyretrosPeetivestudybased onthe0IniemationalClassificationofDiseasesICD一10diseaseelassifieation PrineiPle.(2)Thegeneralinformation,funetionofimPortantorgansofaceident trauma,injuryandPoisoningandeerebralvaseularaceidentdeathswereanalysed, andtakenthemasthePoteniialDCDwasevaluated(3)Theralativesofthefatalities inaceidenitrauma,eerebralvaseularaeeidentwereinvestigatedbyquestionnaireon theirorgantransPlantawareness,attitudesandwilloforgandonation. [Resultsl(1)ThroughtheanalysisofdeatheauseofZ,702easesinTianjinFirst CenterHosPitalbetween2007and2009,thelargestProPortionwaseaneer, aceoUntingfor24.32%ofallthedeaths,followedbyresPiratorydiseases(20.32%), eireulatorysystemdiseases(18.84%),injuryandPoisoning(9.88%)andneurological diseases(9.84%).267easesdiedofinjury)Poisoningandaceidentalwhiehwere mainlytheyoungPeoPleaged15to44yearsgrouP(accountingfor48.690/0).They weremainlyduetoearaeeidentseansed(aecountingfor65.92%).(2)117easesmet theeliniealstandardofliverandkidneydonationthroughtheeomPrehensive assessmentof127easesdiedoftrafficaeeidentinjury,eerebralvascularaceideni, aceountingfor4.33%oftotalnumberofeases.(3)Theinvestigationofthefamilies havingdeathsfromearaceidenttrauma,injuryandPoisoning,andeerebrovaseular accidenishowedthatmostPeoPle(51,33%)hadneverheardoftheorgan transPlantation,33.33%ofthePeoPlehadthedonatedwillthemselves.36.67%of themdisagreedwithfamilymembers.donation,but42.00%ofthemtrendtomaking thedeeisionofdonationaftertheirfalllilymembers,dissusion. [Conelusion]Thepreventionandtreatmentofthetopfivediseasesbyeauseof deathshouldbereinforeedtoredueethefatalityrateandimProvethequalityoflife. /J天津医科大学硕士学位报告 InordertomainiainthehomeostasisofthePotentialdonorofDCD,suehasthe stabilizationofhaemodynamiesandthefunetionofendoerinesystem,themedieal workersshouldoPtimizethecorrelativeexaminationsduringadmittingandtreating thePatientswitheriticalillness.Thiswouldbenefitforinereasingthenumberof Potentialdonors.ThePubliestillhadrnuchvacancyonunderstandingandeognizing totheorgandonation.TheeorrelateddePartmenisshouldstrengthenthedynamism andbroadtheexteniofsoeialProPagandaontheorgandonation.Theyshould PermeateitsaffirmativemeaninginiothesehoolingtomakethePublierecognizeits signifieaneegradually.50that,wemightsuffieientlydiseovermorePotential Postulantsfororgandonation.Therestillhaslongwayto90andneedextensive SuPPorttoit. Kevwords:ho印italmortalitystatistiealanalysisorgantran印lantationo玛an donationaftereardiacdeatheitizenedueation 111 了天津医科大学硕士学位报告 目录 中文摘要..................,......................................,............................................I Abstract..................................................................................................................11 目录...............................................................................................................,.IV 符号说明.............................................................................................................Vn 前言.........................................................................................................................1 研究现状!成果...................................................................................1 研究目的!方法..,.............................................................,.#2 一!天津市第一中心医院院内死亡患者死因分析.............................................4 1.1对象和方法..............................................................................#4 1.1.1资料来源........................................................................................#.4 1.1.2调查方法.,...............................................................................#...#4 1.1.3统计学处理..........................,.........................,.......................#.4 1.2结果...................................................................................................................4 1.2.1病死率分析.....................................................................#4 1.2.1.1不同性别的病死率分析.............................................................4 1.2.1.2不同年龄段的病死率分析.,.................................................5 1.2.2死亡原因构成..................................................................#6 1.2.2.1不同年龄的死亡原因构成及顺位............................................6 1.2.2.2不同性别的死亡原因构成及顺位.............................................7 1.2.2.3不同年度的死亡原因构成及顺位.............................................8 1.2.3主要死亡原因具体分析.......................................................................8 1.2.3.1恶性肿瘤死亡情况.....................................................................8 1.2.3.2呼吸系统疾病死亡情况..........................................................10 1.2.3.3循环系统疾病死亡情况..........................................................10 1.2.3.4损伤!中毒等意外死亡情况..................................................10 1.3讨论.................................................................................................................12 1.4小结.................................................................................................................13 二!医院内心脏死亡器官捐献(DCD)的潜在可行性研究...........................巧 2.1对象与方法............................................................................................,.15 夕天津医科大学硕士学位报告 2.1.1病例选择.............................................................................................巧 2.1.2潜在DCD的判定........,..........,...............................................巧 2.1.3潜在DCD的具体分析.......................................................................巧 2.1.4统计学分析...................................,...............................................16 2.2结果................................................................................................................17 2.2.1潜在DCD供