Yoshioka T, Sugimoto H, Uenishi M, Sakamoto T, Sadamitsu D, Sakano T, Sugimoto T
Neurosurgery. 1986 May;18(5):565-7. doi: 10.1227/00006123-198605000-00009.
The present study attempted long term hemodynamic maintenance in 16 adult brain-dead patients, 14 with head injury and 2 with cerebrovascular accidents. In addition to respiratory and fluid management, 10 were treated with continuous infusion of epinephrine to maintain systolic blood pressure above 90 mm Hg. The remaining 6 patients each received a continuous infusion of synthetic arginine vasopressin (ADH) at a rate of 1 or 2 units/hour (285 +/- 45 microunits/kg/minute) simultaneously with epinephrine. The 10 patients treated with epinephrine alone all succumbed to cardiac arrest within 48 hours of brain death, with a mean survival time of 24.1 +/- 17.2 hours. In the patients who received simultaneous ADH infusion, a minimal dose of epinephrine of no more than 0.5 mg/hr in most instances sufficed to maintain blood pressure. Their mean survival time after brain death was remarkably prolonged to 23.1 +/- 19.1 days. In brain death, ADH plays a critical role in hemodynamic maintenance, and ADH administration permits long term hemodynamic stabilization of brain-death patients, offering increasing opportunities for organ transplantation.
本研究尝试对16例成年脑死亡患者进行长期血流动力学维持，其中14例为头部受伤患者，2例为脑血管意外患者。除呼吸和液体管理外，10例患者接受肾上腺素持续输注以维持收缩压高于90 mmHg。其余6例患者在接受肾上腺素治疗的同时，均以1或2单位/小时（285±45微单位/千克/分钟）的速率接受合成精氨酸加压素（抗利尿激素）持续输注。仅接受肾上腺素治疗的10例患者在脑死亡后48小时内均死于心脏骤停，平均存活时间为24.1±17.2小时。在同时接受抗利尿激素输注的患者中，多数情况下不超过0.5毫克/小时的最小剂量肾上腺素足以维持血压。他们脑死亡后的平均存活时间显著延长至23.1±19.1天。在脑死亡中，抗利尿激素在血流动力学维持中起关键作用，给予抗利尿激素可使脑死亡患者实现长期血流动力学稳定，为器官移植提供越来越多的机会。
