Bode H, Sauer M, Pringsheim W
University Children's Hospital, Freiburg, West Germany.
Arch Dis Child. 1988 Dec;63(12):1474-8. doi: 10.1136/adc.63.12.1474.
The blood flow velocities in the basal cerebral arteries can be recorded at any age by transcranial Doppler sonography. We examined nine children with either initial or developing clinical signs of brain death. Soon after successful resuscitation increased diastolic flow velocities indicated a probable decrease in cerebrovascular resistance; this was of no particular prognostic importance. As soon as there was a clinical deterioration, there was a reduction in flow velocities with retrograde flow during early diastole, probably due to an increase in cerebrovascular resistance; this indicated a doubtful prognosis. In eight of the nine children with clinical signs of brain death a typical reverberating flow pattern was found, which was characterised by a counterbalancing short forward flow in systole and a short retrograde flow in early diastole. This indicated arrest of cerebral blood flow. One newborn showed normal systolic and end diastolic flow velocities in the basal cerebral arteries for two days despite clinical and electroencephalographic signs of brain death. Shunting of blood through the circle of Willis without effective cerebral perfusion may explain this phenomenon. No patient had the typical reverberating flow pattern without being clinically brain dead. Transcranial Doppler sonography is a reliable technique, which can be used at the bedside for the confirmation or the exclusion of brain death in children in addition to the clinical examination.
经颅多普勒超声检查可在任何年龄记录大脑基底动脉的血流速度。我们检查了9名有脑死亡初始或进展期临床体征的儿童。成功复苏后不久，舒张期血流速度增加表明脑血管阻力可能降低；这并无特殊的预后意义。一旦出现临床恶化，血流速度就会降低，舒张早期出现逆流，这可能是由于脑血管阻力增加所致；这表明预后可疑。在9名有脑死亡临床体征的儿童中，有8名发现了典型的振荡血流模式，其特征是收缩期有短暂的正向血流与舒张早期的短暂逆向血流相互抵消。这表明脑血流停止。一名新生儿尽管有脑死亡的临床和脑电图体征，但大脑基底动脉的收缩期和舒张末期血流速度在两天内均正常。血液通过 Willis 环分流而无有效的脑灌注可能解释了这一现象。没有患者在临床上没有脑死亡的情况下出现典型的振荡血流模式。经颅多普勒超声检查是一种可靠的技术，除临床检查外，还可在床边用于确认或排除儿童脑死亡。
