Scherer R, Erhard J, Giebler R, Schmutzler M, Schoeppe W
Institut für Anästhesiologie, Universitätsklinikums der Gesamthochschule Essen.
Zentralbl Chir. 1992;117(12):637-41.
Brain death is associated with loss of hypothalamic, pituitary and brain stem function resulting in apnea, bradycardia and hypotension, poikilothermia, and diabetes insipidus. In order to preserve body functions mechanical ventilation is continued with the aim to maintain an arterial partial pressure of oxygen of more than 100 mmHg. Previous fluid restrictions and the application of diuretics during the treatment of high intracranial pressure frequently result in dehydration. Progressive vasodilation may induce severe hypotension and fluid replacement with cristalloids and if necessary colloids may be called for until the central venous pressure reaches 10 cm H2O. Continuous substitution of potassium and the use of hypotonic solutions such as glucose 5% may avoid hypokalaemia and hypernatraemia, respectively. Inotropic support with dopamine (5-10 micrograms/kg.min) or adrenaline (0.01-0.1 micrograms/kg.min) may be needed to maintain normal mean arterial blood pressure (65 mmHg). Polyuria (5000 ml/24 h) can be treated by continuous intravenous infusion of antidiuretic hormone (0.5-2-10 U/h). Hypothermia must be prevented by warming all fluids (37 degrees C) and covering the patient with heat saving blankets.
脑死亡与下丘脑、垂体和脑干功能丧失相关，导致呼吸暂停、心动过缓和低血压、体温随环境变化、尿崩症。为维持身体功能，需持续进行机械通气，目标是使动脉血氧分压维持在100 mmHg以上。先前在治疗高颅内压期间的液体限制和利尿剂应用常导致脱水。进行性血管舒张可能诱发严重低血压，需用晶体液进行液体补充，必要时可使用胶体液，直至中心静脉压达到10 cm H₂O。持续补钾并使用低渗溶液（如5%葡萄糖）可分别避免低钾血症和高钠血症。可能需要用多巴胺（5 - 10微克/千克·分钟）或肾上腺素（0.01 - 0.1微克/千克·分钟）进行强心支持，以维持正常平均动脉血压（65 mmHg）。多尿（5000毫升/24小时）可通过持续静脉输注抗利尿激素（0.5 - 2 - 10单位/小时）进行治疗。必须通过将所有液体加热至（37摄氏度）并给患者盖上保暖毯来预防体温过低。
