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目的 探讨准确、客观评估脑死亡的方法。方法 2 0 0 2年 4月至 2 0 0 3年 4月神经重症监护治疗病房采用临床指标及脑电图、脑干诱发电位 (BAEP)、短潜伏期体感诱发电位 (SLSEP)和经颅多普勒超声 (TCD)等实验室指标对 11例脑死亡进行动态评估研究。结果 全部病例深昏迷 ,格拉斯哥昏迷评分 3分 ,脑干反射和脑神经支配的活动消失。全部病例脑电波静息 ,其中 3例存在静息过程。全部病例BAEP主波消失 ,1例存在主波消失过程。全部病例SLSEP的N13以后波形消失。TCD检测除 1例为极重度颅内压增高血流改变外 ,其他全部为脑死亡血流特征。自主呼吸诱发试验和阿托品试验为脑死亡提供了最后的证据。脑死亡的主要原因是呼吸心跳骤停、急性低氧血症和(或 )低血压。结论 实验室多项评估指标结合 ,尤其是临床指标与实验室指标的结合 ,以及动态观察可提高判断的准确性。
Objective To explore an accurate and objective way to evaluate brain death. Methods From April 2002 to April 2003, patients with neurological intensive care unit were enrolled in this study. The clinical parameters, electroencephalogram, brainstem response potential (BAEP), short latency somatosensory evoked potentials (SLSEP) Lechner ultrasound (TCD) and other laboratory indicators of 11 cases of brain death dynamic assessment study. Results All patients were deep coma, Glasgow coma score 3, brainstem reflex and brain activity disappeared. All cases of brain wave rest, in which there are three resting process. In all cases, the main wave of BAEP disappeared, and in one case, the main wave disappeared. The waveform disappeared after N13 of all cases SLSEP. TCD test in addition to a case of very severe intracranial pressure increased blood flow changes, the other all for brain death blood flow characteristics. Spontaneous respiratory induction test and atropine test provide the ultimate evidence of brain death. The main causes of brain death are respiratory arrest, acute hypoxemia and / or hypotension. Conclusion The combination of multiple assessment indicators in the laboratory, especially the combination of clinical indicators and laboratory indicators, and dynamic observation can improve the accuracy of the judgment.