High prevalence of decreased cortisol reserve in brain-dead potential organ donors
High prevalence of decreased cortisol reserve in brain-dead potential organ donors
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DOI：
10.1097/01.ccm.0000059644.54819.67
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发表时间：
2003-04-01
影响因子：
8.8
通讯作者：
Roussos, C
中科院分区：
文献类型：
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作者：
Dimopoulou, I;Tsagarakis, S;Roussos, C
目的：研究脑死亡患者的肾上腺皮质功能。设计：前瞻性研究。地点：两所教学医院的重症监护室。患者：37例重型颅脑损伤患者，男28例，女9例，平均年龄42+/-18岁。A组为20例未恶化至脑死亡的脑损伤患者。B组包括17例脑死亡的脑损伤患者，其中10例在ICU期间发生脑死亡，7例在临床脑死亡后进入ICU。干预：所有患者(A组和B组)在入院时采集晨血测定基线血浆皮质醇。随后，静脉注射1杯促肾上腺皮质激素(肾上腺皮质激素，Synacten)，并在注射后30分钟抽取血样。B组在ICU治疗期间脑死亡10例，在确认脑死亡后的第二天早上重复相同的程序。皮质醇水平在给予促肾上腺皮质激素后至少为18µg/dL的患者被定义为应答者。测量和主要结果：发生后。在脑死亡方面，B组患者基线水平(8.5+/-6.2)显著低于对照组(17.0+/-6.6µg/dL，P
Objective: To investigate the adrenocortical function in brain-dead patients, potential organ donors.Design: Prospective study.Setting: Intensive care units in two teaching hospitals.Patients: A total of 37 patients (28 men, nine women) with severe brain injury, having a mean age of 42+/-18 yrs, were included in the study. Group A consisted of 20 brain-injured patients who did not deteriorate to brain death. Group B included 17 brain-injured patients who were brain dead; of these, ten patients developed brain death during ICU stay and seven patients were admitted to the ICU after clinical brain death.Interventions: In all patients (group A and group B), a morning blood sample was obtained at admission to the ICU to determine baseline plasma cortisol. Subsequently, 1 mug of corticotropin (adrenocorticotropic hormone, Synacthen) was administered intravenously, and a blood sample was taken 30 mins after the injection. In group B patients who became brain dead while being treated in the ICU (n=10), the same procedure was repeated the morning after the confirmation of brain death. Patients having a cortisol level of at least 18 mug/dL after the administration of adrenocorticotropic hormone were defined as responders.Measurements and Main Results: After the occurrence. of brain death, group B patients had significantly lower values for baseline (8.5+/-6.2 vs. 17.0+/-6.6 mug/dL, p