脑死亡患者的自主呼吸激发试验应用与安全

Application and Safety of Apnea Test for Patients with Brain Death

脑死亡是指包括脑干在内的全脑功能的不可逆转丧失,其判定是一个复杂的过程。在强烈的呼吸刺激(呼吸性酸中毒)下促发自主呼吸是脑干功能的重要标志,因此自主呼吸激发试验(AT)是脑死亡判定的关键组成部分之一。由于试验期间所有呼吸机支持暂时被移除且允许动脉血二氧化碳分压升高,所以该过程需密切监测患者生命体征。虽然AT已被广泛应用,但目前仍缺乏可用于预防其并发症的实际程序、监测参数和基于证据的安全措施共识,未来需进一步研究。

Brain death refers to irreversible loss of whole brain function including brainstem,and its determination is a complicated process.Spontaneous respiration induced by intense respiratory stimulation( respiratory acidosis) is an important marker of brainstem function.Therefore,apnea test( AT) is one of the key components in the determination of brain death.Since all ventilator support is temporarily removed during AT and partial pressure of carbon dioxide in arterial blood is allowed to rise,the patients’ vital signs should be closely monitored during this process.Although AT has been widely used,there is still no consensus on the practical procedures,monitoring parameters and evidence-based safety measures that can be used to prevent its complications,and further research is needed in the future.