Combes J C, Nicolas F, Lenfant F, Cros N, D'Athis P, Freysz M
Département d'anesthésie-réanimation, hôpital général, CHU, Dijon, France.
Ann Fr Anesth Reanim. 1996;15(8):1173-7. doi: 10.1016/s0750-7658(97)85875-3.
In France, an apnoea test is compulsory to confirm brain death. This test results in a major hypercarbia and respiratory acidosis. This study aimed to assess haemodynamic changes elicited by the apnoea test.
Prospective clinical study.
Fifteen patients with brain death
Before the apnoea test, the lungs were ventilated with pure oxygen for 20 minutes. Thereafter, the test was conducted with continuous oxygen flow through the endotracheal tube, and SpO2 monitoring. Blood gases and haemodynamic parameters, including systemic arterial pressure, pulmonary artery pressure, pulmonary artery occlusion pressure, cardiac index and right ventricular function parameters were assessed before, during and 20 minutes after the apnoea test. Mean values at the various times were compared.
Hypercarbia and acidosis induced a major pulmonary hypertension and an increase in cardiac output, associated with a decrease in systemic vascular resistances. Despite pulmonary hypertension and acidosis, right ventricular function was maintained. All haemodynamic modifications were reversed by reventilation.
Apnoea test induces a reversible pulmonary hypertension that is seemingly not deleterious for right ventricular function. Apnoea test probably does not alter viability of the donor's organs.
在法国，必须进行一项呼吸暂停测试以确认脑死亡。该测试会导致严重的高碳酸血症和呼吸性酸中毒。本研究旨在评估呼吸暂停测试引发的血流动力学变化。
前瞻性临床研究。
15例脑死亡患者
在呼吸暂停测试前，用纯氧对肺部进行20分钟通气。此后，通过气管内导管持续供氧并监测SpO2来进行测试。在呼吸暂停测试前、测试期间及测试后20分钟评估血气和血流动力学参数，包括体动脉压、肺动脉压、肺动脉闭塞压、心脏指数和右心室功能参数。比较不同时间的平均值。
高碳酸血症和酸中毒导致严重的肺动脉高压及心输出量增加，同时体循环血管阻力降低。尽管存在肺动脉高压和酸中毒，但右心室功能得以维持。所有血流动力学改变通过重新通气得以逆转。
呼吸暂停测试会引发可逆的肺动脉高压，这似乎对右心室功能无害。呼吸暂停测试可能不会改变供体器官的活力。
