多种激素联合使用对脑死亡器官捐献供者血流动力学的影响

Effect of multiple hormone applications for hemodynamics of brain-dead organ donors

目的观察肾上腺素或去甲肾上腺素、去氨加压素、甲泼尼龙和甲状腺素多种激素联合使用改善脑死亡供者血流动力学的作用,为供者器官维护提供重要手段。方法45例潜在脑死亡器官捐献供者,在常规维护基础上,加用甲状腺素、甲泼尼龙、去氨加压素,并根据血压情况再加用去甲肾上腺素和(或)肾上腺素,记录多种激素联合使用第0、1天捐献者的平均动脉压(MAP)、心排出量(CO)、心脏功能指数(CI)、每搏输出量(SV)及全心射血分数(GEF)等血流动力学参数的变化,作多种激素联合使用前后对比分析。结果45例脑死亡捐献者予以多种激素联合使用前,MAP为(48.49±10.69)mmHg,CO为(2.55±0.71)L/min,CI为(1.57±0.43)L/min·m2,SV为(28.38±11.16)ml,GEF为(32.56±12.43)%,均较正常值显著降低,与正常值下限比较,差异均有统计学意义(P<0.05)。予多种激素联合使用1 d后,MAP为(87.99±7.35)mmHg,CO为(6.49±1.05)L/min,CI为(4.01±0.68)L/min·m2,SV为(60.21±8.75)ml,GEF为(69.08±10.34)%,均在正常范围内,与激素使用前比较,血流动力学各指标均明显改善(P<0.05)。结论应用多种激素后脑死亡器官潜在捐献者血流动力学明显改善,待捐献器官血流灌注得到保障,成功捐献,可为脑死亡器官捐献者维护提供临床应用研究依据。

Objective To summarize the effect of multiple hormone applications of adrenaline/noradrenaline,desmopressin,meprednisone and thyroxine for hemodynamics of brain-dead organ donors so as to provide rationales for maintaining brain-dead organ donors.Methods A total of 45 brain-dead organ donors received regular therapy plus levothyroxine sodium tablets,meprednisone and desmopressin.Adrenaline and noradrenaline were tailored to the variations of blood pressure.The changes of hemodynamic parameters,such as mean arterial pressure(MAP),cardiac output(CO),cardiac index(CI),stroke volume(SV)and global ejection fraction(GEF)were recorded at Day 0 and Day 1.Results The hemodynamic parameters of 45 brain-dead organ donors,including MAP(48.49±10.69)mmHg,CO(2.55±0.71)L/min,CI(1.57±0.43)L/min·m2,SV(28.38±11.16)ml and GEF(32.56±12.43)%were lower than normal values before multiple hormone applications.As compared with the lower limits of normal values,the differences were statistically significant(P<0.05).All hemodynamic parameters,including MAP(87.99±7.35)mmHg,CO(6.49±1.05)L/min,CI(4.01±0.68)L/min·m2,SV(60.21±8.75)ml and GEF(69.08±10.34)%,were within normal ranges at Day 1 after multiple hormone applications.As compared with those before hormone dosing,hemodynamic parameters improved significantly(P<0.05).Conclusions The hemodynamic parameters of brain-dead potential organ donors improve significantly after multiple hormone applications,ensuring blood perfusion of awaited donated organs.Therefore organ donors may be donated successfully.Thus our study provides clinical rationales for maintaining brain-dead organ donors.