脑死亡26例临床诊断报告

Clinical diagnosis of 26 cases of brain death

目的 探讨脑死亡的临床诊断标准。方法 对 2 6例病因明确的脑死亡患者进行了脑干反射、GCS昏迷量表、瞳孔大小、肢体反射等常规检测 ;其中 10例进行了呼吸暂停试验 ,5例脑电图(EEG) Holter监测 ;2 1例脑死亡患者进行阿托品试验 ,按 1mg、2mg、5mg分组 ,并与 15例深昏迷患者对照分析。结果 呼吸暂停试验阳性与选用的人工呼吸机性能有关 ;脑死亡组阿托品试验阴性与深昏迷对照组比较结果有显著差异 (P <0 .0 5 ) ;EEG Holter对确定脑死亡时间具有重要鉴定价值 ;瞳孔改变包括双瞳散大 19例、双瞳缩小 2例、双瞳大小不等 5例 ;肢体反射存在 5例。结论 推荐 1个呼吸暂停试验规范操作方案 ;阿托品 1mg为首选用量 ;动态脑电图具有法医学鉴定价值 ;瞳孔散大和肢体反射消失并非脑死亡的特征之一。

Objective To explore clinical diagnostic criterion of brain death. Methods Evaluation was made on 26 cases of brain death through routine check-up such as brain stem reflex, GCS, pupil dilatation and limbs reflex. Among whom apnea test was made in 10 cases and EEG-Holter monitoring in 5 cases.Different dose of 1 mg,2 mg,5 mg Atropine test in 21 cases of brain death were administered to compare with the result in another 15 cases of deep coma patients. Results The positive of apnea test has some relation with the mode of respirator executed. The negative of Atropine test in brain death group has significant difference with that of deep coma group( P <0.05). EEG-Holter is valuable in determining the exact time of brain death. Pupil changes including mydriasis 14 cases, miosis 2 cases and inequality of pupil 5 cases. Limbs reflex was preserved in 5 cases. Conclusions A protocol for executing apnea is recommended. Atropine 1 mg should be the first dosage when executing Atropine test.Dynamic EEG has forensic value while mydriasis and loss of limbs reflex should not be regarded as characteristic sign of brain death.