Hansen H-C, Günther U
Klinik für Neurologie, Friedrich-Ebert-Krankenhaus Neumünster, Friesenstraße 11, 24534, Neumünster, Deutschland.
Universitätsklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Oldenburg AöR, Rahel-Straus-Str. 10, 36133, Oldenburg, Deutschland.
Med Klin Intensivmed Notfmed. 2019 Mar;114(2):114-121. doi: 10.1007/s00063-018-0527-6. Epub 2019 Jan 15.
In 2015, the German Medical Association (Bundesärztekammer) issued new guidelines on the diagnosis of the "irreversible loss of brain function" (ILBF). ILBF replaced the colloquial term "brain death" in order to leave the notion that concepts of death might vary such as "cardiac death" or "apparent death" and stress the objective medical-scientific matter. The German Transplantation Law describes ILBF as "the final, irreversible loss of all function of the cerebrum, cerebellum, and brainstem." The new guidelines are to be followed closely. They demand higher qualifications of physicians involved in the diagnosis of ILBF and emphasize at the same time the interdisciplinary approach and the mandatory involvement of at least one specialist in the neurological field. Several technical methods were added as additional tools to support the ILBF diagnosis such as CT-angiography and duplex ultrasound of brain and neck vessels. The new guidelines thereby raise the impact of demonstrating complete cerebral circulatory arrest but leave other options to prove irreversibility. Many procedures, such as the apnea test, were specified in more detail. This article summarizes the new features of the new guideline with a practical overview on who must be involved in the diagnosis of ILBF, how often, how the diagnosis is achieved stepwise from stage I to III and how it is secured as well as what technical methods may be involved at what stage of the procedure.
2015年，德国医学协会（德国医师公会）发布了关于“脑功能不可逆丧失”（ILBF）诊断的新指南。ILBF取代了通俗说法“脑死亡”，以便摒弃死亡概念可能存在差异（如“心脏死亡”或“假死”）的观念，并强调客观的医学科学问题。德国《移植法》将ILBF描述为“大脑、小脑和脑干所有功能的最终、不可逆丧失”。必须严格遵循新指南。它们要求参与ILBF诊断的医生具备更高资质，同时强调跨学科方法以及至少一名神经领域专家的强制参与。增加了几种技术方法作为支持ILBF诊断的额外工具，如脑和颈部血管的CT血管造影及双功超声。新指南由此提高了证明完全脑循环停止的影响力，但也留下了证明不可逆性的其他选择。许多程序，如呼吸暂停试验，都有了更详细的规定。本文总结了新指南的新特点，并对谁必须参与ILBF诊断、频率如何、如何从第一阶段到第三阶段逐步完成诊断及如何确保诊断、以及在诊断过程的哪个阶段可能涉及哪些技术方法进行了实际概述。
