成人脑死亡自主呼吸激发试验的研究进展

Recent advance in apnea test in adult brain death

自主呼吸激发试验(AT)是判定成人脑死亡的关键步骤, 它提供了成人脑死亡患者脑干功能丧失的重要依据。近年来, 随着成人脑死亡判定和器官捐献移植的逐步开展, 各国在制定成人脑死亡判定标准中更加注重AT实施的标准化和规范化, 医务工作者们也针对AT实施过程中出现的问题不断进行探索和改良。本文现围绕当前AT的实施标准、经典AT的潜在风险及其并发症、AT的改良探索、体外膜肺氧合下的AT实施、AT失败后的对策及辅助检查的应用等方面进行综述, 以期加深脑死亡判定医师对AT的认知了解, 推动AT更加规范、有序地开展。

Apnea test(AT)is a key step in the diagnosis of adult brain death,which provides important basis for the loss of brainstem function in patients with adult brain death.In recent years,with extensive development of adult brain death determination and organ donation transplantation,discussion and research of AT have been gradually promoted.In formulation of adult brain death criteria,countries have paid more attention to the standardization and normalization of AT implementation,and medical staffs have improved the AT implementation process.This article reviews the current AT implementation standards,conventional AT procedures and complications,modified AT exploration,AT implementation with extracorporeal membrane oxygenation,and treatments and auxiliary examinations after AT failure,in order to deepen the understanding and cognition of adult brain death determination physicians on AT,and promote AT development in a more standardized and orderly way.