Changes of heart, liver, kidney and endocrine glands in brain death.

在28例脑死亡患者中，同时静脉注射平均剂量0.3mU/kg/min的精氨酸加压素和额外的小剂量肾上腺素，不仅可以稳定地控制全身平均动脉压在80 mm Hg以上，而且还可以稳定地控制尿崩症一周以上。通过循环参数分析，在加压素和肾上腺素的支持下，心输出量和全身血管阻力均维持在正常水平。心电图在前两天频发ST段压低，但逐渐恢复正常。心脏活检标本取自右室间隔。光镜下可见肌丝萎缩肥大，间质水肿。线粒体损伤的严重程度各有不同，但在电子显微镜下呈逐渐加重趋势。我们研究的临床资料显示，大多数病例肾功能正常，进行性黄疸。组织病理学正常…尸检时肾组织中可见肾小球增多，肾小管上皮细胞脱落。肝组织内可见正常肝细胞和胆管内胆管病变。胆管炎的严重程度取决于从脑死亡到心搏停止的程度。这些组织病理学表现与临床资料相吻合。并观察脑死亡后脑垂体腺激素的变化。ACTH、HGH、LH、FSH、TSH和催乳素等垂体前叶激素水平在脑死亡后的几天内均可检测到。TSH和催乳素水平均随TRH负荷的增加而增加。这两个解剖学特征解释了垂体前叶的这种残留功能。首先，脑下垂体在骨性结构中被保护，不受脑突出的直接压力。垂体下动脉和被膜动脉经硬膜外入路汇入垂体节。提示脑死亡后，脑垂体腺前叶至少部分存活。较少

In twenty-eight brain death patients simultaneous intravenous administration of arginine vasopressin at an average dose 0.3mU/kg/min and an additional small dose of epinephrine could steadily control not also systemic mean arterial pressure over 80 mmHg, but also diabetes insipidus for more than a week. Through the analysis of circulatory parameters both cardiac output and systemic vascular resistance were maintained in the normal level with the support of vasopressin and epinephrine. ECG revealed ST depression frequently in the first two days, but became normal gradually. The cardiac biopsy specimens were obtained from right ventricular septum. They showed atrophy and hypertrophy of myofilaments and interstitial edema in light microscopy. Severity of mitochondrial ianjury was various in every case, but it was supposed becoming worse gradually in electron microscope. Clinical data in our study showed normal renal function and progressive jaundice in most cases. Histopathologically norm … More al glomeruli and desquamation of epithelial cells of tubulus were observed in the specimens of kidney at autopsy. Normal hepatocytes and cholangiolitic changes were observed in the liver specimens. Severity of cholangiolitis depended on the furation from brain death to asystole. These histopathologic findings were comparable to the clinical data. We also studied the change of pituitary galnd after brain death. Basal serum levels of anterior pituitary hormones like ACTH, HGH, LH, FSH, TSH and prolaction were all detectable for seceral days after brain death. TSH and prolaction were both increased in response to added load of TRH. This remaining function of anterior pituitary gland was explained by the two anatomical peculiarities. Firstly, pituitary gland is protected from the direct compressive force of cerebral herniation in the bony structure. Inferior pituitary arteries and capsular arteries run into pituitary galnd through extradural approach. It was suggested that anterior lobe of pituitary gland still survived at least partially after brain death. Less