美国神经病学家关于脑死亡的调查：脑死亡的概念基础和诊断测试的理解。
A survey of American neurologists about brain death: understanding the conceptual basis and diagnostic tests for brain death.
机构信息
Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.
出版信息
Ann Intensive Care. 2012 Feb 17;2(1):4. doi: 10.1186/2110-5820-2-4.
BACKGROUND
Neurologists often diagnose brain death (BD) and explain BD to families in the intensive care unit. This study was designed to determine whether neurologists agree with the standard concept of death (irreversible loss of integrative unity of the organism) and understand the state of the brain when BD is diagnosed.
METHODS
A previously validated survey was mailed to a random sample of 500 board-certified neurologists in the United States. Main outcomes were: responses indicating the concept of death that BD fulfills and the empirical state of the brain that would rule out BD.
RESULTS
After the second mailing, 218 (44%) surveys were returned. Few (n = 52, 27%; 95% confidence interval (CI), 21%, 34%) responded that BD is death because the organism has lost integrative unity. The most common justification was a higher brain concept (n = 93, 48%; 95% CI, 41%, 55%), suggesting that irreversible loss of consciousness is death. Contrary to the recent President's Council on Bioethics, few (n = 22, 12%; 95% CI, 8%, 17%) responded that the irreversible lack of vital work of an organism is a concept of death that the BD criterion may satisfy. Many responded that certain brain functions remaining are not compatible with a diagnosis of BD, including EEG activity, evoked potential activity, and hypothalamic neuroendocrine function. Many also responded that brain blood flow and lack of brainstem destruction are not compatible with a diagnosis of BD.
CONCLUSIONS
American neurologists do not have a consistent rationale for accepting BD as death, nor a clear understanding of diagnostic tests for BD.
背景
神经科医生经常在重症监护病房诊断脑死亡（BD）并向家属解释 BD。本研究旨在确定神经科医生是否同意标准的死亡概念（生物体整合统一性的不可逆转丧失），并了解诊断 BD 时大脑的状态。
方法
我们向美国随机抽取的 500 名已获得委员会认证的神经科医生邮寄了一份先前经过验证的调查问卷。主要结果是：表示 BD 符合死亡概念的答复，以及排除 BD 的大脑实际状态。
结果
第二次邮寄后，有 218 份（44%）调查问卷返回。很少有（n = 52，27%；95%置信区间（CI），21%，34%）认为 BD 是死亡，因为生物体已经失去了整合统一性。最常见的理由是高级大脑概念（n = 93，48%；95% CI，41%，55%），这表明意识的不可逆转丧失就是死亡。与最近的总统生物伦理委员会相反，很少有（n = 22，12%；95% CI，8%，17%）认为生物体不可逆转缺乏重要功能是 BD 标准可能满足的死亡概念。许多人认为，某些大脑功能的保留与 BD 的诊断不兼容，包括脑电图活动、诱发电位活动和下丘脑神经内分泌功能。许多人还认为，脑血流和脑干破坏的缺乏与 BD 的诊断不兼容。
结论
美国神经科医生对接受 BD 作为死亡的依据没有一致的理由，也没有明确了解 BD 的诊断测试。
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