Jan Mohammed M
Department of Pediatrics, King Abdul-Aziz University Hospital, PO Box 80215, Jeddah 21589, Kingdom of Saudi Arabia. Tel. +996 (2) 6401000 Ext. 20208. Fax. +996 (2) 6403975. E-mail:
Neurosciences (Riyadh). 2008 Oct;13(4):350-5.
Brain death implies the permanent absence of all cerebral and brainstem functions. The diagnosis of brain death is usually made clinically. The criteria require the occurrence of acute and irreversible CNS insult. Drug intoxication, poisoning, metabolic derangements, and hypothermia should be corrected for accurate brain death evaluation. At least 2 expert examiners are required to make the brain death determination. It is advisable to involve an independent examiner not involved in the patients care or the recovery of donated organs. The objective of this article is to present updated guidelines for the process of brain death determination. All brain and brainstem functions should be absent on neurological examination including cerebral response to external stimuli and brain stem reflexes. An apnea test should be performed in all patients. However, if the clinical criteria cannot be applied, other confirmatory ancillary tests are required, particularly EEG, and radionuclide scan. They are also needed to supplement the clinical assessment in young children. An EEG is more reliable in the setting of hypotension or with disorders that lower intracranial pressure. While tests of brain blood flow are preferred in the setting of hypothermia, metabolic, or drug confounders.
脑死亡意味着大脑和脑干的所有功能永久丧失。脑死亡的诊断通常在临床上进行。诊断标准要求发生急性且不可逆的中枢神经系统损伤。为了准确评估脑死亡，应纠正药物中毒、中毒、代谢紊乱和体温过低的情况。至少需要两名专家检查人员来判定脑死亡。建议邀请一名不参与患者护理或捐赠器官获取的独立检查人员参与。本文的目的是提供脑死亡判定过程的最新指南。神经系统检查应显示所有大脑和脑干功能均缺失，包括大脑对外部刺激的反应和脑干反射。所有患者均应进行呼吸暂停试验。然而，如果无法应用临床标准，则需要其他确证性辅助检查，尤其是脑电图（EEG）和放射性核素扫描。在幼儿中，这些检查也用于补充临床评估。在低血压或伴有降低颅内压的疾病情况下，脑电图更可靠。而在体温过低、代谢或药物干扰的情况下，脑血流检查则更为可取。
