Truog R D, Fackler J C
Department of Anesthesia, Children's Hospital, Harvard Medical School, Boston, MA 02115.
Crit Care Med. 1992 Dec;20(12):1705-13. doi: 10.1097/00003246-199212000-00018.
To evaluate whether current criteria for the diagnosis of brain death fulfill the requirement for the "irreversible cessation of all functions of the entire brain, including the brainstem."
Clinical, philosophical, legal, and public policy literature on the subject of brain death.
DATA EXTRACTION/SYNTHESIS: We advance four arguments to support the view that patients who meet the current clinical criteria for brain death do not necessarily have the irreversible loss of all brain function. First, many clinically brain-dead patients maintain hypothalamic-endocrine function. Second, many maintain cerebral electrical activity. Third, some retain evidence of environmental responsiveness. Fourth, the brain is physiologically defined as the central nervous system, and many clinically brain-dead patients retain central nervous system activity in the form of spinal reflexes. We explore options for resolving these inconsistencies between the conceptual definition and the clinical criteria used to make the diagnosis of brain death.
Brain death is a valid conception of death because it signifies the permanent loss of consciousness. Brain death criteria should therefore be based on the diagnosis of the permanent loss of consciousness rather than that of the loss of vegetative brain functions. Revision of our current "whole brain" definition of brain death to a "higher brain" standard should be considered.
评估当前脑死亡诊断标准是否满足“全脑包括脑干的所有功能不可逆停止”这一要求。
关于脑死亡主题的临床、哲学、法律及公共政策文献。
资料提取/综合：我们提出四个论点来支持以下观点，即符合当前脑死亡临床标准的患者不一定存在所有脑功能的不可逆丧失。其一，许多临床脑死亡患者维持下丘脑 - 内分泌功能。其二，许多患者维持脑电活动。其三，一些患者保留对环境有反应的证据。其四，从生理学角度讲，脑被定义为中枢神经系统，许多临床脑死亡患者以脊髓反射的形式保留中枢神经系统活动。我们探讨解决脑死亡概念定义与用于诊断脑死亡的临床标准之间这些不一致性的选项。
脑死亡是一种有效的死亡概念，因为它意味着意识的永久丧失。因此，脑死亡标准应基于对意识永久丧失的诊断，而非对脑的植物性功能丧失的诊断。应考虑将我们当前脑死亡的“全脑”定义修订为“高级脑”标准。
