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

对28例脑死亡患者，静注精氨酸加压素（平均剂量0.3mU/kg/min）加用小剂量肾上腺素，不仅能使体循环平均动脉压稳定在80 mmHg以上，而且能使尿崩症稳定控制一周以上。通过对循环参数的分析，在血管加压素和肾上腺素的支持下，心输出量和体循环阻力均维持在正常水平。心电图显示ST段压低在前两天频繁，但逐渐恢复正常。心脏活检标本取自右室间隔。光镜下肌丝萎缩、肥大，间质水肿。电镜下线粒体损伤程度不同，但呈逐渐加重趋势。我们的临床资料显示，大多数病例肾功能正常，黄疸进展。历史规范 ...更多信息 尸检肾脏标本中可见肾小球萎缩和肾小管上皮细胞脱落。在肝脏标本中观察到正常肝细胞和胆管炎性改变。毛细胆管炎的严重程度取决于脑死亡到心搏停止的时间。这些组织病理学结果与临床数据相当。并对脑死亡后垂体激素的变化进行了研究。脑死亡后连续几天检测基础血清ACTH、HGH、LH、FSH、TSH和催乳素水平。促甲状腺激素和催乳素都增加响应于增加TRH负荷。垂体前叶的这种残存功能可以用两个解剖学特点来解释。首先，脑下垂体被保护免受脑疝在骨性结构中的直接压力。垂体下动脉和被膜动脉经硬膜外入路进入垂体。提示脑死亡后垂体前叶仍有部分存活。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