Kinoshita Y, Yahata K, Okamoto K, Yoshioka T, Sugimoto T
Department of Traumatology and Emergency Medicine, Osaka University School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1991 Jul;92(7):771-4.
Brain dead donor can not be maintained the systemic circulation more than 48 hours despite rather large dosage of catecholamine. The combined administration of arginine vasopressin (ADH) and catecholamine (epinephrine or dopamine) succeeded in long-term circulatory maintenance after brain death. We examined the renal and hepatic function by the method of circulatory maintenance. Twenty brain dead patients were randomly separated into two groups. Ten patients were maintained the systemic blood pressure with ADH and epinephrine (Group E). And the other ten were maintained with ADH and dopamine (Group D). Circulation was maintained with a small dosage of catecholamine at least six days in all donors. Urine output was well controlled, and serum BUN and creatinine were normal for 14 days. Daily creatinine clearance was always normal in both groups. Serum GPT, cholinesterase and alkaliphosphatase were the same in both groups, but total bilirubin was lower in group D than in group E on the seventh day. The combination of ADH and catecholamine preserved the kidney and liver after brain death for more than a week. This method will be of great value in organ transplantation from brain dead organ donors.
尽管使用了相当大剂量的儿茶酚胺，脑死亡供体也无法维持全身循环超过48小时。精氨酸加压素（抗利尿激素）与儿茶酚胺（肾上腺素或多巴胺）联合使用成功地在脑死亡后长期维持了循环。我们通过循环维持方法检查了肾功能和肝功能。20例脑死亡患者被随机分为两组。10例患者用抗利尿激素和肾上腺素维持全身血压（E组）。另外10例用抗利尿激素和多巴胺维持（D组）。所有供体均用小剂量儿茶酚胺维持循环至少6天。尿量得到良好控制，血清尿素氮和肌酐在14天内均正常。两组的每日肌酐清除率始终正常。两组的血清谷丙转氨酶、胆碱酯酶和碱性磷酸酶相同，但在第7天，D组的总胆红素低于E组。抗利尿激素和儿茶酚胺的联合使用在脑死亡后使肾脏和肝脏功能维持了一周以上。这种方法在脑死亡器官供体的器官移植中将具有重要价值。
