Wijdicks Eelco F M
Division of Critical Care Neurology, College of Medicine, Mayo Clinic, Rochester, Minnesota.
Semin Neurol. 2015 Apr;35(2):105-15. doi: 10.1055/s-0035-1547532. Epub 2015 Apr 3.
Brain death is diagnosed in the minority of patients with acute severe brain injury. Guidelines have been developed in many countries in the world and physicians usually work through a set of criteria. The clinical evaluation starts with determination of futility of any medical or surgical intervention and an unmistakable certainty that the underlying diagnosis is correct. The actual neurologic evaluation in a patient suspected of being brain dead requires 25 tests and verifications. Brain death determination demands perfect diagnostic accuracy and thus requires skill and expertise. The overriding principle is simple: establish cause, exclude confounders, determine futility of interventions, examine brainstem reflexes, and test for apnea. In this review, the author revisits the American Academy of Neurology guidelines, and examines the details behind the guidelines. The 2010 guidelines have eliminated unnecessary tests and observation delays, and maintain a principle of simplicity.
在少数急性重度脑损伤患者中会诊断出脑死亡。世界上许多国家都制定了相关指南，医生通常会依据一系列标准进行诊断。临床评估首先要确定任何医疗或手术干预是否徒劳无益，以及对潜在诊断的正确性有明确无误的把握。对疑似脑死亡患者进行实际的神经学评估需要25项检查和验证。脑死亡的判定要求具备完美的诊断准确性，因此需要专业技能和专业知识。首要原则很简单：确定病因，排除混淆因素，判定干预措施是否徒劳，检查脑干反射，并进行呼吸暂停测试。在这篇综述中，作者重新审视了美国神经病学学会的指南，并审视了这些指南背后的细节。2010年的指南消除了不必要的检查和观察延误，并秉持了简单性原则。
