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

在28例脑死亡患者中，同时静脉给予平均剂量0.3mU/kg/min的精氨酸加压素和额外小剂量的肾上腺素，不仅可以稳定地控制全身平均动脉压超过80 mmHg，而且可以控制尿崩症超过一周。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。心电图前2天多见ST段压低，后逐渐恢复正常。心脏活检标本取自右室间隔。光镜下表现为肌丝萎缩肥大，间质水肿。各病例线粒体损伤程度各不相同，但电镜观察呈逐渐加重趋势。在我们的研究中，临床资料显示大多数患者肾功能正常，并伴有进行性黄疸。解剖肾标本可见较多的肾小球和小管上皮细胞脱屑。肝标本中可见正常肝细胞及胆管结石改变。胆管炎的严重程度取决于脑死亡到心脏骤停的转变。这些组织病理学结果与临床数据相当。我们还研究了脑死亡后脑垂体的变化。脑死亡后数天内检测垂体前叶激素如ACTH、HGH、LH、FSH、TSH和催乳素的基础血清水平。TSH和增殖均随TRH负荷的增加而增加。脑下垂体前叶的剩余功能可由两个解剖特点来解释。首先，脑垂体免受脑疝在骨结构中的直接压缩力的保护。垂体下动脉和囊状动脉经硬膜外入路进入垂体腺。提示脑死亡后脑垂体前叶至少部分存活。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