Pérez-Blanco Alicia, Caturla-Such Juan, Cánovas-Robles José, Sanchez-Payá José
Unidad de Cuidados Intensivos, Hospital General de Elda, Ctra. de Elda a Sax, 03600 Elda Alicante, Spain.
Intensive Care Med. 2005 Jul;31(7):943-8. doi: 10.1007/s00134-005-2662-9. Epub 2005 Jun 4.
We compared hemodynamic values, oxygen utilization, and adenine nucleotide concentration in the extracted organs of brain-dead donors treated with triiodothyronine vs. standard support treatment.
Prospective, randomized, double-blind controlled study.
We recruited 52 consecutive adult cadaveric organ donors. Inclusion criteria were diagnosis of brain-death, transplantation suitability, and family consent for donation; exclusion criterion was preexisting thyroid disease.
The treatment group (n=29) received an intravenous bolus of 1 microg/kg triiodothyronine followed by continuous perfusion at 0.06 microg/kg per hour, and controls (n=23) received 0.9% ClNa delivered over 270 min. Hemodynamics, tonometry, thyroid hormones, and serum lactate were measured every 90 min from brain death to extraction procedure. Biopsies were processed to determine adenine nucleotides concentration.
Hemodynamic measurements did not differ significantly in the two groups, and the inotrope dose could not be diminished after treatment. Thyrotropin levels increased from brain death to extraction procedure in controls. Thyrotropin measured 90 and 180 min after the beginning of the perfusion was significantly lower in the treatment group than controls. The Pco2 gap increased in both groups from brain death to the extraction procedure. The lactate level of the treatment group was lower than in controls. Biopsy specimens were obtained in 19 controls and in 20 donors of the treatment group; the adenine nucleotides concentration did not show any significant difference.
Triiodothyronine did not add any benefit over the standard management of the organ donor nor did it affect the adenine nucleotides concentration of any biopsied organs.
我们比较了接受三碘甲状腺原氨酸治疗的脑死亡供体与接受标准支持治疗的脑死亡供体在摘取器官时的血流动力学值、氧利用情况和腺嘌呤核苷酸浓度。
前瞻性、随机、双盲对照研究。
我们连续招募了52名成年尸体器官供体。纳入标准为脑死亡诊断、适合移植以及家属同意捐赠；排除标准为既往存在甲状腺疾病。
治疗组（n = 29）静脉推注1微克/千克三碘甲状腺原氨酸，随后以0.06微克/千克每小时的速度持续灌注，对照组（n = 23）在270分钟内输注0.9%氯化钠溶液。从脑死亡到摘取器官的过程中，每90分钟测量一次血流动力学、张力测定、甲状腺激素和血清乳酸水平。对活检组织进行处理以确定腺嘌呤核苷酸浓度。
两组的血流动力学测量结果无显著差异，治疗后强心剂剂量也未减少。对照组从脑死亡到摘取器官的过程中促甲状腺激素水平升高。治疗组灌注开始后90分钟和180分钟时测得的促甲状腺激素水平显著低于对照组。两组从脑死亡到摘取器官的过程中Pco2差值均增加。治疗组的乳酸水平低于对照组。在19名对照组和20名治疗组供体中获取了活检标本；腺嘌呤核苷酸浓度无显著差异。
与器官供体的标准管理相比，三碘甲状腺原氨酸未带来任何益处，也未影响任何活检器官的腺嘌呤核苷酸浓度。
