Department of Neurology, Henry Ford Hospital, Detroit, MI, USA.
Neurocrit Care. 2011 Dec;15(3):547-53. doi: 10.1007/s12028-011-9561-4.
Although the new Practice Parameters for brain death support a single examination, there is paucity of data comparing its impact to dual brain death (DBD) examinations.
We reviewed all brain deaths in our hospital over a 39-month period and compared the optional single brain death (SBD) exam requiring an apnea and a mandatory confirmatory blood flow test to the DBD for organ function at the time of death, rate of donation, and cost.
Thirty-six patients had a SBD and 59 DBD exams, without any of them regaining neurological functioning. There was no difference in serum electrolytes (except for higher Na(+) and Cl(-) in the SBD group), blood urea nitrogen, creatinine, blood gases, incidence of diabetes insipidus, apnea completion, consent for donation, and organs recovered and transplanted. During the second BD exam, 35% of patients with DBD were on higher dose of vasopressors, but had lower systolic blood pressure (P = 0.046). For DBD patients, the mean interval between the two exams was 14.4 h, which contributed to a higher cost of $43,707.67 compared to SBD. There was a trend for increased consent rates (adjusted for age, race, and type of exam) when patients were declared by the neurointensivist service following a strict family approach protocol (P = 0.06).
SBD exam is easier, faster to perform, with no brain function recovery and leads to similar donation rates, equivalent or better organ function status at the time of BD and lower cost than conventional DBD exams.
尽管新的脑死亡实践参数支持单次检查，但缺乏比较其与双脑死亡（DBD）检查影响的数据。
我们回顾了 39 个月内我院所有的脑死亡病例，并比较了可选的单次脑死亡（SBD）检查（需要进行一次呼吸暂停和强制性的血流确认试验）与死亡时器官功能的 DBD、捐赠率和成本。
36 例患者进行了 SBD 检查，59 例进行了 DBD 检查，没有一例恢复神经功能。血清电解质（SBD 组的 Na+和 Cl-较高除外）、血尿素氮、肌酐、血气、尿崩症发生率、呼吸暂停完成、捐赠同意率以及所获得和移植的器官没有差异。在第二次 DBD 检查中，35%的 DBD 患者使用了更高剂量的血管加压素，但收缩压较低（P=0.046）。对于 DBD 患者，两次检查之间的平均间隔为 14.4 小时，这导致费用比 SBD 高 43707.67 美元。在神经重症监护服务按照严格的家庭方法协议宣布后，随着年龄、种族和检查类型的调整，同意率呈上升趋势（P=0.06）。
SBD 检查更容易、更快完成，没有脑功能恢复，并且导致相似的捐赠率、在 DBD 时相当或更好的器官功能状态以及比传统的 DBD 检查更低的成本。
