Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea -
Minerva Anestesiol. 2013 Sep;79(9):1011-20. Epub 2013 May 6.
Pathophysiologic changes after brain death can lead to acid-base disturbances. The primary aim of this study was to clarify the acid-base state and its source in brain dead donors using Stewart's approach. Additionally, we investigated whether the presence of metabolic acidosis affected the number of organs retrieved from donors.
A retrospective review of electronic medical records was performed for brain dead donors who had undergone organ harvesting during the past 5 years in a tertiary medical center. The parameters related to acid-base disturbance and the number of organs retrieved from the donors was assessed.
Sixty one brain dead donors were evaluated in this study. Twenty three (37.7%) of these patients had metabolic acidosis at the initial diagnosis of brain death. Metabolic acidosis resulted from hyperchloremia and a large strong ion gap. The severity of metabolic acidosis was masked by hypernatremia and hypoalbuminemia. In addition, donors without metabolic acidosis also showed mixed acid-base disturbances in which metabolic acidosis induced by significant hyperchloremia was combined with metabolic alkalosis caused by hypoalbuminemia and hypernatremia. Although more organs were retrieved from the donors without metabolic acidosis than those with metabolic acidosis (P=0.012), serum albumin level (P=0.010) and donor age (P<0.001), rather than metabolic acid-base disturbances, significantly correlated with the number of organs retrieved in multivariate regression analysis.
Most brain dead donors exhibited metabolic acid-base disturbances. However, rather than metabolic acidosis, serum albumin level and donor age were well correlated with the number of organs retrieved.
脑死亡后病理生理变化可导致酸碱失衡。本研究的主要目的是使用斯图尔特法阐明脑死亡供者的酸碱状态及其来源。此外，我们还研究了代谢性酸中毒的存在是否影响供者所获取器官的数量。
对过去 5 年在一家三级医疗中心进行器官采集的脑死亡供者的电子病历进行回顾性分析。评估与酸碱紊乱相关的参数以及从供者中获取器官的数量。
本研究共评估了 61 例脑死亡供者。其中 23 例（37.7%）在脑死亡初始诊断时即存在代谢性酸中毒。代谢性酸中毒由高氯血症和大的强离子间隙引起。高钠血症和低白蛋白血症掩盖了代谢性酸中毒的严重程度。此外，无代谢性酸中毒的供者也表现出混合性酸碱紊乱，其中显著高氯血症引起的代谢性酸中毒与低白蛋白血症和高钠血症引起的代谢性碱中毒相结合。尽管无代谢性酸中毒的供者比有代谢性酸中毒的供者获取的器官更多（P=0.012），但血清白蛋白水平（P=0.010）和供者年龄（P<0.001），而不是代谢性酸碱紊乱，在多变量回归分析中与获取器官的数量显著相关。
大多数脑死亡供者存在代谢性酸碱紊乱。然而，与代谢性酸中毒相比，血清白蛋白水平和供者年龄与获取器官的数量密切相关。
