每日一题_2022.5.12

A 29-year-old man hanged himself and is resuscitated at the site by emergency medical services for pulseless electrical activity arrest lasting 19 minutes. On arrival in the emergency department, he is comatose. Temperature-targeted therapy is initiated on ICU admission. He remains comatose. Two days after completion of hypothermia, his pupils become widely dilated without reaction to light and, as the day progresses, he is declared dead by neurologic criteria. Other than depression, he had had no major medical illness before his hanging. His family has given consent for organ donation. Therapy has now been directed toward optimization of organ function before procurement.

Which of the following hormone replacement strategies should be taken into account?

A. Thyroid supplementation should be initiated with thyroxine rather than triiodothyronine.

B. A vasopressin infusion should be considered for hypotension refractory to fluids.

C. High-dose corticosteroids serve no utility and should not be administered.

D. Hyperglycemia should be managed aggressively to achieve normoglycemia.

答案解析:

脑死亡后常见内分泌缺陷,因为面对颅内压升高导致脑无血流,下丘脑和垂体易受缺氧性损伤。血管加压素不仅在治疗尿崩症(常见于脑死亡)方面有价值,而且还可作为治疗血管舒张引起的低血压的一线药物。

高剂量皮质类固醇被认为可减少脑死亡过程中激活的全身炎症的损伤作用,治疗与移植后器官功能改善相关。甲状腺替代治疗在管理血流动力学不稳定或心功能不全显示左心室射血分数低于45%的供体方面特别有用。虽然三碘甲状腺原氨酸的活性起效更快,但已证实两者的有效性相当。高血糖在脑死亡供体中很常见,其固有代谢后果与典型ICU患者相同。虽然没有涉及该人群血糖控制的特定研究,但有证据表明高血糖会影响捐献器官的功能。因此,指导典型重症患者血糖控制的文献被外推至潜在器官供体的护理。因此,管理应符合当地ICU高血糖指南和方案。

正确答案:B

补充内容:中国成人脑死亡判定标准与操作规范(第二版)

每日一题_2022.5.12
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