Kinoshita Y, Okamoto K, Yahata K, Yoshioka T, Sugimoto T, Kawaguchi N, Onishi S
Department of Traumatology, Osaka University Hospital, Japan.
Pathol Res Pract. 1990 Feb;186(1):173-9. doi: 10.1016/S0344-0338(11)81027-7.
In ten brain death patients circulatory stability was attained with both vasopressin and a minimum dose of epinephrine for more than a week. Clinical and pathological changes of the heart after brain death were examined in this model. ST-T wave changes of ECG were initially observed in 57%. The required dose of epinephrine to maintain the systemic blood pressure was rather high in the first two days after brain death and could be reduced below 0.1 kg/min in a steady state. Normal level of CPK-MB in this study indicated that the damage of the heart was reversible. The cardiac biopsy specimens from the right ventricular septum were obtained serially and they showed normal or slightly swollen mitochondria. The mitochondrial scores were below 1.0 in seven patients, and they were elevated to more than 1.0 in three patients with prolonged shock. The heart of brain death was suppressed by the shock at brain death, but it could be preserved in good condition for several days with our circulatory support which uses both arginine vasopressin and epinephrine.
在10例脑死亡患者中，使用血管加压素和最小剂量的肾上腺素使循环稳定维持了一周多时间。在此模型中对脑死亡后心脏的临床和病理变化进行了研究。心电图ST-T段改变最初见于57%的患者。脑死亡后的前两天，维持体循环血压所需的肾上腺素剂量相当高，而在稳定状态下可降至0.1μg/min以下。本研究中肌酸磷酸激酶同工酶（CPK-MB）水平正常表明心脏损伤是可逆的。连续获取右心室间隔的心脏活检标本，结果显示线粒体正常或轻度肿胀。7例患者的线粒体评分低于1.0，3例长时间休克患者的线粒体评分升高至1.0以上。脑死亡时的休克抑制了脑死亡患者的心脏，但通过我们使用精氨酸血管加压素和肾上腺素的循环支持，心脏可在数天内保持良好状态。
