Department of Neurology, ACC 739A, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
Neurocrit Care. 2009;11(2):276-87. doi: 10.1007/s12028-009-9231-y. Epub 2009 May 15.
Since the establishment of the concept of declaring death by brain criteria, a large extent of variability in the determination of brain death has been reported. There are no standardized practical guidelines, and major differences exist in the requirements for the declaration of brain death throughout the USA and internationally. The American Academy of Neurology published evidence-based practice parameters for the determination of brain death in adults in 1995, requiring the irreversible absence of clinical brain function with the cardinal features of coma, absent brainstem reflexes, and apnea, as well as the exclusion of reversible confounders. Ancillary tests are recommended in cases of uncertainty of the clinical diagnosis. Every step in the determination of brain death bears potential pitfalls which can lead to errors in the diagnosis of brain death. These pitfalls are presented here, and possible solutions identified. Suggestions are made for improvement in the standardization of the declaration of brain death.
自从宣布脑死亡标准的概念建立以来，已经报道了在确定脑死亡方面存在很大程度的可变性。目前没有标准化的实用指南，并且在美国和国际范围内，宣布脑死亡的要求存在很大差异。美国神经病学学会于 1995 年发布了成人脑死亡判定的循证实践参数，要求不可逆地缺乏临床脑功能，具有昏迷、脑干反射消失和无呼吸等主要特征，并排除可逆性混淆因素。在临床诊断不确定的情况下，建议进行辅助检查。脑死亡判定的每一个步骤都存在潜在的陷阱，可能导致脑死亡诊断错误。本文提出了这些陷阱，并确定了可能的解决方案。对脑死亡宣告的标准化提出了改进建议。
