Salim A, Vassiliu P, Velmahos G C, Sava J, Murray J A, Belzberg H, Asensio J A, Demetriades D
Department of Surgery, University of Southern California Keck School of Medicine, USA.
Arch Surg. 2001 Dec;136(12):1377-80. doi: 10.1001/archsurg.136.12.1377.
Levothyroxine sodium therapy should be used in brain-dead potential organ donors to reverse hemodynamic instability and to prevent cardiovascular collapse, leading to more available organs for transplantation.
Prospective, before and after clinical study.
A surgical intensive care unit of an academic county hospital.
During a 12-month period (September 1, 1999, through August 31, 2000), we evaluated 19 hemodynamically unstable patients with traumatic and nontraumatic intracranial lesions, who were candidates for organ donation following brain death declaration.
All patients were resuscitated aggressively for organ preservation by fluids, inotropic agents, and vasopressors. If, despite all measures, the patients remained hemodynamically unstable, a bolus of 1 ampule of 50% dextrose, 2 g of methylprednisolone sodium succinate, 20 U of insulin, and 20 microg of levothyroxine sodium was administered, followed by a continuous levothyroxine sodium infusion at 10 microg/h.
There was a significant reduction in the total vasopressor requirement after levothyroxine therapy (mean +/- SD, 11.1 +/- 0.9 microg/kg per minute vs 6.4 +/- 1.4 microg/kg per minute, P =.02). Ten patients (53%) had complete discontinuation of vasopressors. There were no failures to reach organ donation due to cardiopulmonary arrest.
Levothyroxine therapy plays an important role in the management of hemodynamically unstable potential organ donors by decreasing vasopressor requirements and preventing cardiovascular collapse. This may result in an increase in the quantity and quality of organs available for transplantation.
对于脑死亡的潜在器官捐献者，应使用左甲状腺素钠治疗以逆转血流动力学不稳定并预防心血管衰竭，从而获得更多可用于移植的器官。
前瞻性前后对照临床研究。
一所县级学术医院的外科重症监护病房。
在12个月期间（1999年9月1日至2000年8月31日），我们评估了19例因创伤性和非创伤性颅内病变导致血流动力学不稳定的患者，这些患者在脑死亡宣告后成为器官捐献候选人。
所有患者均通过补液、血管活性药物和血管加压药进行积极复苏以保存器官。如果尽管采取了所有措施，患者仍血流动力学不稳定，则给予1安瓿50%葡萄糖、2g琥珀酸钠甲泼尼龙、20U胰岛素和20μg左甲状腺素钠静脉推注，随后以10μg/h的速度持续输注左甲状腺素钠。
左甲状腺素治疗后血管加压药的总需求量显著降低（均值±标准差，每分钟11.1±0.9μg/kg对比6.4±1.4μg/kg，P = 0.02）。10例患者（53%）完全停用了血管加压药。没有因心肺骤停而未能实现器官捐献的情况。
左甲状腺素治疗在血流动力学不稳定的潜在器官捐献者的管理中发挥着重要作用，可降低血管加压药需求并预防心血管衰竭。这可能会增加可用于移植的器官数量和质量。
