From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, The University of Arizona, Tucson, Arizona.
J Trauma Acute Care Surg. 2014 May;76(5):1301-5. doi: 10.1097/TA.0000000000000184.
Protocols call for the start of hormonal therapy with levothyroxine after the declaration of brain death. As the hormonal perturbations occur during the process of brain death, the role of the early initiation of levothyroxine therapy (LT) to salvage organs is not well defined. The aim of this study was to evaluate the impact of early LT (before the declaration of brain death) on the number of solid organs procured per donor.
We performed an 8-year retrospective analysis of all trauma patients who progressed to brain death. Patients who consented for organ donation, received LT, and donated solid organs were included. Patients were dichotomized into two groups: early LT group, patients who received LT before the declaration of brain death, and late LT group, those who received LT after brain death. The two groups were compared for differences in demographics, clinical characteristics, need for vasopressor, and number of solid organ donation.
A total of 100 solid organ donors were identified of which, 41% (n=77) donors who received LT therapy were included. LT before the declaration of brain death was initiated in 37 patients compared with 40 patients who had it started after the declaration of brain death. There was no difference in demographics between the two groups except that patients in the early LT group were more likely to be hypotensive on presentation (54% vs. 25%, p = 0.001). Early LT therapy was associated with an increase in solid organ procurement rate (odds ratio, 1.9; 95% confidence interval, 1.4-2.7; p = 0.01). Sixty-seven patients donated a total of 291 solid organs.
The early use of LT and aggressive blood product resuscitation was associated with a significantly higher number of solid organs donated per donor. Earlier use of LT before the declaration of brain death may be considered in potential organ donors.
Therapeutic/care management study, level IV.
在宣布脑死亡后，应开始使用左甲状腺素进行激素治疗。由于在脑死亡过程中会发生激素紊乱，因此早期开始左甲状腺素治疗（LT）以抢救器官的作用尚未明确。本研究旨在评估早期 LT（在宣布脑死亡之前）对每位供者获取的实体器官数量的影响。
我们对所有进展为脑死亡的创伤患者进行了 8 年的回顾性分析。纳入同意进行器官捐献、接受 LT 并捐献实体器官的患者。将患者分为两组：早期 LT 组，LT 在脑死亡前接受治疗的患者；晚期 LT 组，LT 在脑死亡后接受治疗的患者。比较两组患者的人口统计学、临床特征、血管加压药需求和实体器官捐献数量的差异。
共确定了 100 名实体器官捐献者，其中接受 LT 治疗的患者中有 41%（n=77）纳入研究。与脑死亡后开始 LT 的 40 例患者相比，有 37 例患者在脑死亡前开始 LT。两组患者的人口统计学特征无差异，除了早期 LT 组患者在就诊时更可能出现低血压（54%比 25%，p=0.001）。早期 LT 治疗与实体器官获取率的增加相关（比值比，1.9；95%置信区间，1.4-2.7；p=0.01）。67 例患者共捐献了 291 个实体器官。
LT 的早期使用和积极的血制品复苏与每位供者捐献的实体器官数量显著增加相关。在潜在器官捐献者中，可考虑在宣布脑死亡之前更早地开始 LT 治疗。
治疗/护理管理研究，IV 级。
