Shimizu N, Shemie S, Miyasaka E, Matsumoto H, Miyasaka K, Gilday D, Barker G
Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Canada.
Masui. 2000 Oct;49(10):1126-32.
The medical records of all brain dead patients (n = 228) at the Hospital for Sick Children, Toronto from January 1990 to December 1999 were reviewed. A radionuclide cerebral blood flow study (RCBFS) as a supportive and confirmatory test was performed on 27 patients and the clinical diagnosis of brain death was confirmed on all of them. A RCBFS was performed on 10 out of 27 patients because full clinical evaluation could not be performed due to severe facial injuries or cervical injuries. A RCBFS was performed on 17 patients who underwent a full clinical evaluation, of which 15 cases were due to uncertainty in the clinical etiology of the deep coma and 2 cases were due purely to the need to persuade the family. In recent years, RCBFS was not used as extensively on patients who underwent a full clinical evaluation, reflecting social acceptance and a higher level of clinical certainty in diagnosing brain death in children. This study supports the opinion that brain death can be accurately diagnosed in pediatric patients with clinical criteria alone and confirmatory tests are not necessary in most cases.
回顾了1990年1月至1999年12月期间多伦多病童医院所有脑死亡患者（n = 228）的病历。对27例患者进行了放射性核素脑血流研究（RCBFS）作为支持性和确认性检查，所有患者的脑死亡临床诊断均得到证实。27例患者中有10例因严重面部损伤或颈部损伤无法进行全面临床评估而进行了RCBFS。对17例接受全面临床评估的患者进行了RCBFS，其中15例是由于深度昏迷临床病因不确定，2例纯粹是为了说服家属。近年来，RCBFS在接受全面临床评估的患者中使用并不广泛，这反映了社会的接受程度以及儿童脑死亡诊断中临床确定性的提高。本研究支持这样一种观点，即仅通过临床标准就能准确诊断儿科患者的脑死亡，大多数情况下无需进行确认性检查。
