Hashemian Seyed Mohammadreza, Delavarkasmaei Hosein, Najafizadeh Katayoun, Mojtabae Meysam, Ardehali Seyed Hossein, Kamranmanesh Mohammad Reza, Basharzad Niloofar, Ghorbani Fariba
Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Tanaffos. 2016;15(4):213-217.
Diagnosis of brain death relies on clinical and electroencephalographic (EEG) criteria. Waiting for 24 hours is mandatory to make definitive diagnosis of the condition in the Iranian protocol. Although it has been previously shown that oscillatory or spiked systolic or reversed diastolic flow patterns in transcranial Doppler sonography (TCD) are associated with faster brain death confirmation, it has not yet been approved in our protocol. Thus, the aim of this study was to assess the applicability of this method to our organ donation system.
This study was performed in Masih Daneshvari Organ Procurement Unit from July to December 2009. TCD from the middle cerebral and basilar arteries was attempted in 35 patients who fulfilled the clinical and EEG criteria for brain death. Extensive skull defects and hypotension (blood pressure < 80 mmHg) were the exclusion criteria. Examinations were made for about 30 minutes via temporal and occipital windows as soon as possible after diagnosis of brain death.
The mean age of cases was 31.9±14.78 years and 18 (51.4%) were males. The most prevalent cause of brain death was trauma (in 19 or 54.2% of cases). We were unable to detect any intracranial artery in 2 (5.7%) cases. There were no false negative or false positive results in the remaining ones. Detected ultrasonic patterns of cerebral vascular flow were systolic spike and oscillating signal in 29 (87.9%) and 4 (12.1%) donors, respectively.
Our study showed that TCD results in brain dead cases were concordant with clinical and EEG criteria. Therefore, TCD, as a confirmatory test, can be applied for rapid diagnosis of brain death.
脑死亡的诊断依赖于临床和脑电图（EEG）标准。在伊朗的方案中，必须等待24小时才能对该病做出明确诊断。尽管先前已表明经颅多普勒超声检查（TCD）中的振荡性或尖峰状收缩期或舒张期反向血流模式与更快的脑死亡确认相关，但该方法尚未在我们的方案中得到批准。因此，本研究的目的是评估该方法在我们器官捐献系统中的适用性。
本研究于2009年7月至12月在马西·达内什瓦里器官采购单位进行。对35例符合脑死亡临床和EEG标准的患者进行了大脑中动脉和基底动脉的TCD检查。广泛的颅骨缺损和低血压（血压<80 mmHg）为排除标准。在诊断脑死亡后尽快通过颞窗和枕窗进行约30分钟的检查。
病例的平均年龄为31.9±14.78岁，男性18例（51.4%）。脑死亡的最常见原因是创伤（19例，占54.2%）。2例（5.7%）患者未检测到任何颅内动脉。其余患者未出现假阴性或假阳性结果。检测到的脑血管血流超声模式分别为29例（87.9%）供者的收缩期尖峰和4例（12.1%）供者的振荡信号。
我们的研究表明，脑死亡病例的TCD结果与临床和EEG标准一致。因此，TCD作为一种确证性检查，可用于脑死亡的快速诊断。
