Washida M, Okamoto R, Manaka D, Yokoyama T, Yamamoto Y, Ino K, Yamamoto N, Osaki N, Shimahara Y, Yamaoka Y
Second Department of Surgery, Faculty of Medicine, Kyoto University, Japan.
Transplantation. 1992 Jul;54(1):44-9. doi: 10.1097/00007890-199207000-00007.
The influence of combined replenishment of L-3,5,3'-triiodothyronine (T3) and vasopressin (antidiuretic hormone [ADH]) on both hepatic metabolism and systemic hemodynamics was assessed in brain-dead dogs. Arterial ketone body ratio (AKBR) was measured as a parameter of hepatic metabolism, which reflects the redox state (free nicotinamide adenine dinucleotide/reduced nicotinamide adenine dinucleotide) of liver mitochondria. Mean arterial blood pressure (MAP) was significantly decreased from 110.4 +/- 3.8 to 44.4 +/- 1.7 mmHg, at 1 hr after completion of brain death (P less than 0.01). In the control group AKBR was maintained thereafter at near control value of 1.0 with a significant decrease in serum lactate concentration in spite of marked hypotension. T3 infusion at a rate of 1 microgram/kg/hr elevated the AKBR but did not elevate MAP. Vasopressin infusion at a rate of 0.1 U/kg/hr sustained AKBR and elevated MAP significantly at 1 hr after administration but tended to decrease thereafter. Combined administration of T3 and ADH elevated the AKBR to about 2.0, and MAP was restored to near-normal level. Other parameters such as glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and lactic dehydrogenase, reflecting liver cell injury and serum creatinine, and blood urea nitrogen as renal function, were maintained within normal range. These results indicate that combined T3 and vasopressin administration has a beneficial synergistic effect on both hepatic energy metabolism and systemic hemodynamics without any detrimental influence to other conventional parameters. Therefore, it is suggested that this combined administration may contribute to the management of potential multiorgan donors.
在脑死亡犬中评估了联合补充L-3,5,3'-三碘甲状腺原氨酸（T3）和血管加压素（抗利尿激素[ADH]）对肝脏代谢和全身血流动力学的影响。测量动脉酮体比率（AKBR）作为肝脏代谢的参数，其反映了肝线粒体的氧化还原状态（游离烟酰胺腺嘌呤二核苷酸/还原型烟酰胺腺嘌呤二核苷酸）。脑死亡完成后1小时，平均动脉血压（MAP）从110.4±3.8显著降至44.4±1.7 mmHg（P<0.01）。在对照组中，尽管有明显低血压，AKBR此后维持在接近1.0的对照值，血清乳酸浓度显著降低。以1微克/千克/小时的速率输注T3可提高AKBR，但未提高MAP。以0.1 U/千克/小时的速率输注血管加压素可维持AKBR，并在给药后1小时显著提高MAP，但此后趋于下降。联合给予T3和ADH可使AKBR升高至约2.0，MAP恢复至接近正常水平。反映肝细胞损伤的其他参数如谷草转氨酶、谷丙转氨酶和乳酸脱氢酶以及作为肾功能指标的血清肌酐和血尿素氮均维持在正常范围内。这些结果表明，联合给予T3和血管加压素对肝脏能量代谢和全身血流动力学具有有益的协同作用，而对其他传统参数无任何有害影响。因此，提示这种联合给药可能有助于潜在多器官供体的管理。
