Prolonged hemodynamic maintenance by the combined administration of vasopressin and epinephrine in brain death: a clinical study.
Prolonged hemodynamic maintenance by the combined administration of vasopressin and epinephrine in brain death: a clinical study.
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在脑死亡中联合使用加压素和肾上腺素可延长血流动力学维持：一项临床研究。
作者：
Toshiharu Yoshioka;Hisashi Sugimoto;Masaaki Uenishi;Toshihisa Sakamoto;D. Sadamitsu;Tsutomu Sakano;Tsuyoshi Sugimoto
本研究对16例脑死亡患者、14例脑损伤患者和2例脑血管意外患者进行了长期的血流动力学维持。除了呼吸和液体管理外，10名患者还接受了肾上腺素的持续输注，以保持收缩压在90毫米汞柱以上。其余6例患者在注射肾上腺素的同时，以1~2单位/小时(285+/-45微单位/公斤/分钟)的速度持续输注合成精氨酸加压素(ADH)。单用肾上腺素治疗的10例患者均在脑死亡后48小时内死于心脏骤停，平均存活时间为24.1±17.2小时。在同时接受ADH输注的患者中，大多数情况下最小剂量的肾上腺素不超过0.5毫克/小时就足以维持血压。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，ADH在维持血流动力学方面起着关键作用，ADH的应用可以使脑死亡患者的血液动力学长期稳定，为器官移植提供了更多的机会。
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.