Özmert Sengül, Sever Feyza, Ayar Ganime, Yazıcı Mutlu Uysal, Öztaş Dilek Kahraman
Department of Anaesthesiolgy and Reanimation, University of Health Sciences Ankara Child Health and Diseases Haematology Oncology Training and Research Hospital, Ankara, Turkey.
Department of Paediatric Intensive Care Unit, University of Health Sciences Ankara Child Health and Diseases Haematology Oncology Training and Research Hospital, Ankara, Turkey.
Turk J Anaesthesiol Reanim. 2019 Feb;47(1):55-61. doi: 10.5152/TJAR.2019.43726. Epub 2019 Feb 1.
The purpose of the present study was to retrospectively analyse the brain death (BD) cases that were specified within the last 8 years in the paediatric intensive care unit of our hospital.
Archive files and computer records of 23 paediatric cases were analysed. Data on age, gender, conditions that caused BD, paediatric risk of mortality (PRISM III) scores, time between suspicion of BD and issuing of BD report, confirmatory tests used, complications that occurred following the diagnosis of BD and time to cardiac arrest development after diagnosis of BD were recorded.
The average age of the patients was 6.8±5.5 years. The most frequent cause of BD was intracranial haemorrhage (30.4%). The mean time to diagnosis after BD suspicion was 5.9±6.2 days. Electroencephalography was performed in 61% of the patients in addition to the apnoea test. Radiological imaging methods were used in 39% of the patients (n=9). Of the cases, 34.7% developed hypothermia, and 4.3% developed diabetes insipidus (DI). Among them, 43.4% had both DI and hypothermia. The mean PRISM score was calculated as 22±9.2. The donation rate of the families was 17%. The mean time to cardiac arrest development after diagnosis of BD was 6.9±7.4 days in non-donor cases where medical support had been reduced.
Any patient with a neurologically poor prognosis in the intensive care unit should be considered to develop BD and diagnosed with BD without delay. The donation rate will increase if family interviews are done by an experienced and educated coordinator.
本研究旨在回顾性分析我院儿科重症监护病房过去8年内确诊的脑死亡（BD）病例。
分析23例儿科病例的档案文件和计算机记录。记录患者的年龄、性别、导致脑死亡的病因、儿科死亡风险（PRISM III）评分、疑似脑死亡至发布脑死亡报告的时间、所用的确诊检查、脑死亡诊断后发生的并发症以及脑死亡诊断后至心脏骤停发生的时间。
患者的平均年龄为6.8±5.5岁。脑死亡最常见的病因是颅内出血（30.4%）。疑似脑死亡后至诊断的平均时间为5.9±6.2天。除了呼吸暂停试验外，61%的患者还进行了脑电图检查。39%的患者（n = 9）使用了放射影像学方法。在这些病例中，34.7%出现体温过低，4.3%出现尿崩症（DI）。其中，43.4%同时患有尿崩症和体温过低。平均PRISM评分为22±9.2。家属的捐赠率为17%。在减少医疗支持的非捐赠病例中，脑死亡诊断后至心脏骤停发生的平均时间为6.9±7.4天。
重症监护病房中任何神经预后不良的患者都应被视为可能发生脑死亡，并应立即进行脑死亡诊断。如果由经验丰富且受过教育的协调员进行家属访谈，则捐赠率将会提高。
