Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Department of Neurology and Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
J Korean Med Sci. 2020 Mar 23;35(11):e71. doi: 10.3346/jkms.2020.35.e71.
Brain death is a clinical diagnosis that implies irreversible loss of function of the entire brain, including the brainstem and both hemispheres. Based on previous reports, it is not rare for reflex and spontaneous movements to occur in patients during the process of determining brain death. However, reports of the frequency and common types of these movements vary from study to study. Thus, we evaluated adult patients with impending brain death in Korea to determine the frequency and characteristics of reflex and spontaneous movements.
Brain dead patients who were admitted to 15 hospitals in the Yeongnam region (Southeast) of Korea were recruited prospectively from January 2013 to September 2016. All patients met the criteria for brain death as established by the Korea Medical Association. All body movements occurred during the process of diagnosing brain death and were assessed by physicians and trained organ transplant coordinators. The frequency and characteristics of these movements were identified and the demographic and clinical factors of impending brain dead patients with and without these movements were compared.
A total of 436 patients who met the criteria for brain death were enrolled during the study period. Of these patients, 74 (17.0%) exhibited either reflex or spontaneous movements. Of this subset, 45 (60.8%) exhibited reflex movements only, 18 (24.3%) exhibited spontaneous movements only, and 11 (14.9%) exhibited both reflex and spontaneous movements. The most common reflex movements were the flexor/extensor plantar response and spinal myoclonus. Of the 74 patients, 52 (70.3%) exhibited one movement of the same pattern and 22 (29.7%) exhibited two or more different movement patterns. In addition, 45 (60.8%) exhibited these movements only on a limited area of the body with the leg being most common (n = 26, 57.8%). Patients with hypoxic brain damage and a higher systolic blood pressure exhibited significantly more reflex or spontaneous movements.
Movements associated with brain dead patients are not rare and thus an awareness of these movements is important to brain death diagnosis. Physicians who perform brain death examinations should understand the frequency and characteristics of these movements to reduce delays in determining brain death.
脑死亡是一种临床诊断，意味着整个大脑（包括脑干和两个半球）的功能不可逆转地丧失。根据以往的报告，在确定脑死亡的过程中，患者出现反射和自发性运动并不罕见。然而，关于这些运动的频率和常见类型的报告因研究而异。因此，我们评估了韩国即将发生脑死亡的成年患者，以确定反射和自发性运动的频率和特征。
从 2013 年 1 月至 2016 年 9 月，前瞻性地招募了来自韩国岭南地区（东南部）15 家医院的脑死亡患者。所有患者均符合韩国医学会制定的脑死亡标准。所有身体运动均发生在诊断脑死亡过程中，由医生和经过培训的器官移植协调员进行评估。确定这些运动的频率和特征，并比较有无这些运动的即将发生脑死亡患者的人口统计学和临床因素。
在研究期间，共有符合脑死亡标准的 436 名患者入选。其中 74 名（17.0%）患者出现反射或自发性运动。在这一组中，45 名（60.8%）仅出现反射运动，18 名（24.3%）仅出现自发性运动，11 名（14.9%）同时出现反射和自发性运动。最常见的反射运动是屈肌/伸肌跖反射和脊髓肌阵挛。在 74 名患者中，52 名（70.3%）患者表现出相同模式的一种运动，22 名（29.7%）患者表现出两种或更多不同的运动模式。此外，45 名（60.8%）患者仅在身体的有限区域出现这些运动，腿部最常见（n=26，57.8%）。有缺氧性脑损伤和更高的收缩压的患者表现出更多的反射或自发性运动。
与脑死亡患者相关的运动并不罕见，因此了解这些运动对于脑死亡诊断很重要。进行脑死亡检查的医生应该了解这些运动的频率和特征，以减少确定脑死亡的时间延迟。
