Smith Martin
Department of Neurocritical Care, The National Hospital for Neurology and Neurosurgery, University College London Hospitals, UCLH/UCL National Institute for Health Research Biomedical Research Centre, London, United Kingdom.
Semin Neurol. 2015 Apr;35(2):145-51. doi: 10.1055/s-0035-1547534. Epub 2015 Apr 3.
The United Kingdom (UK) has incorporated a brainstem formulation into its brain death criteria since the first guidelines were published in 1976. A clinical diagnosis incorporating three sequential but interdependent steps is sufficient for the determination of brain death in the UK. There must be no doubt that the patient's comatose condition is due to irreversible brain damage of known etiology, and potentially reversible causes of coma and apnea, such as drug effects, metabolic or endocrine disturbances, or hypothermia, must be excluded. A clinical examination of brainstem reflexes and an apnea test is then undertaken. Confirmatory tests are not required in the UK, but may be useful to reduce any element of uncertainty or minimize the period of observation prior to the diagnosis of brainstem death if the preconditions for clinical testing are not met, or if a comprehensive neurologic examination is not possible. Brainstem death must be diagnosed by two doctors who must be present at each of the two sets of clinical tests that are required to determine death. Although death is not confirmed until the second test has been completed, the legal time of death is when the first test confirms the absence of brainstem reflexes.
自1976年首次发布指南以来，英国已将脑干判定标准纳入其脑死亡标准之中。在英国，通过包含三个连续但相互依存步骤的临床诊断就足以判定脑死亡。必须毫无疑问地确定患者的昏迷状态是由已知病因的不可逆脑损伤所致，并且必须排除昏迷和呼吸暂停的潜在可逆病因，如药物作用、代谢或内分泌紊乱或体温过低等。然后进行脑干反射的临床检查和呼吸暂停试验。在英国，并不要求进行确诊试验，但如果不符合临床检测的前提条件，或者无法进行全面的神经系统检查，那么确诊试验可能有助于减少任何不确定性因素，或者在诊断脑干死亡之前将观察期减至最短。脑干死亡必须由两名医生诊断，这两名医生必须出席判定死亡所需的两组临床检查中的每一组。虽然直到第二次检查完成后死亡才得到确认，但法定死亡时间是第一次检查确认脑干反射消失之时。
