Shemie Sam D, Baker Andrew
Division of Critical Care, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Department of Critical Care and Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada.
Semin Neurol. 2015 Apr;35(2):162-8. doi: 10.1055/s-0035-1547538. Epub 2015 Apr 3.
Despite well-described international variabilities in brain death practices, de facto there already exists a minimum international clinical standard for the diagnosis of brain death. This remains rooted in the Harvard criteria and based on the characteristics of a permanently nonfunctioning brain. Medicine is evolving toward a single unified determination of death based on the cessation of brain function subsequent to catastrophic brain injury or circulatory arrest. Clarity in lexicon could be established, including movement toward functional definitions and away from anatomically based terms such as cardiac and brain death that erroneously imply death of the organ. The cessation of clinical functions of the brain that will not resume is determined by the absence of capacity for consciousness, centrally mediated motor responses, brainstem reflexes, and capacity to breathe. A known proximate cause and the absence of confounding or reversible conditions must be confirmed. Regional medical, legal, cultural, religious, or socioeconomic factors may require testing beyond this minimal clinical standard.
尽管脑死亡判定实践在国际上存在着诸多已被充分描述的差异，但事实上，脑死亡诊断已经存在一个最低限度的国际临床标准。这一标准仍然植根于哈佛标准，并基于大脑永久丧失功能的特征。医学正朝着基于灾难性脑损伤或循环骤停后脑功能停止的单一统一死亡判定发展。可以明确术语，包括朝着功能定义发展，摒弃诸如心脏死亡和脑死亡等基于解剖学的术语，因为这些术语错误地暗示了器官的死亡。大脑临床功能不会恢复的停止状态，由意识能力、中枢介导的运动反应、脑干反射以及呼吸能力的缺失来确定。必须确认已知的近因以及不存在混淆或可逆的情况。地区性的医学、法律、文化、宗教或社会经济因素可能需要超出这一最低临床标准进行检测。
