临床脑死亡病例判定12例报告

A discussion of determination on clinical diagnosis of brain death in twelve patients

目的探讨脑死亡的临床判定标准。方法对12例昏迷原因明确且排除各种原因的可逆性昏迷患者进行脑死亡判定。临床判定深昏迷,脑干反射消失,无自主呼吸。确认正中神经短潜伏期体感诱发电位(SLSEP):N9和(或)N13存在,P14、N18和N20消失;脑电图(EEG)显示电静息;经颅多普勒超声(TCD)显示颅内前循环和后循环呈振荡波、尖小收缩波或血流信号消失。以上3项中至少2项阳性,临床判定和确认试验结果均符合脑死亡判定标准者首次判定为脑死亡。首次判定12小时后再次复查,结果仍符合脑死亡判定标准,则确认为脑死亡。结果该组12例患者均符合脑死亡判定标准。结论脑死亡判定具有高度的科学性和严谨性,必须严格按照判定标准进行。

Objective To discuss the clinical diagnostic criteria of brain death. Methods The brain death diagnosis was made in 12 patients who were in irreversible and unresponsive coma of identifiable cause. The potential reversible coma due to any damage or confounding factors was also excluded. The full clinical examination of patients demonstrated irreversible and unresponsive coma, absence of brain stem reflexes, and apnea. The essential findings of the ancillary test verifying brain death were as follows： Short Latency Somatosensory Evoked Potentials（SLSEP）from median nerve stimulation indicated that N9 and/or N13 waves were present, but no waves following P14, N18 and N20 were recordable. Electroencephalography（EEG）showed the absence of electrical activity. Transcranial Doppler Ultrasonography（TCD） confirmed brain death by small systolic peaks in early systole without diastolic flow, or reverberating flow in both anterior and posterior circulations. The patients demonstrated positive results at least two of the above three tests. Patients were diagnosed with brain death after the first round of confirmation was completed when the results of clinical examination and ancillary tests all met the diagnostic criteria for brain death. A second clinical examination and repeated ancillary tests were carried out 12 hours after the first round of confirmation, and the results still met the standards and then brain death was confirmed. Results Twelve patients all met the diagnostic criteria of brain death. Conclusion Clinical diagnosis of brain death is a highly rigorous and scientific work. Medical professionals must closely and strictly follow the brain death criteria to determine brain death.