Valentin A, Karnik R, Winkler W B, Hochfellner A, Slany J
II. Medical Department, Krankenanstalt Rudolfstiftung, Vienna, Austria.
Wien Klin Wochenschr. 1997 Nov 14;109(21):836-9.
Encouraging results in transplant medicine create a growing demand for organ transplant donors. Transcranial Doppler (TCD) has been used by several investigators to assess arrest of the cerebral circulation in brain dead patients. We report on TCD as a monitoring tool for early identification of potential organ transplant donors.
A prospective clinical study.
Intensive care unit (ICU) of a 900-bed community hospital (primary and tertiary care center) in Vienna, Austria.
All patients with acute intracranial lesions admitted to our intensive care unit underwent TCD examination at least once daily. In patients with Glasgow Coma Scores < 7, TCD waveforms with high resistance profiles unchanged by therapeutic attempts to lower intracranial pressure indicated the need for repeated TCD up to four times a day. TCD waveform abnormality consisting of absent or reversed diastolic flow or small early systolic spikes in at least two intracranial arteries was considered to constitute intracranial circulatory arrest. Brain death was confirmed by clinical criteria, an isoelectric electroencephalography (EEG) or non filling of the intracerebral arteries on arteriography.
From January 1994 to July 1996 we identified 11 comatose patients as potential organ transplant donors with typical TCD findings indicating intracranial circulatory arrest. Diagnosis was subarachnoid hemorrhage in 7 and intracerebral hemorrhage in 4 patients. Brain death diagnosis according to the criteria of Austrian law was initiated immediately after the TCD findings suggested intracranial circulatory arrest. Confirmation of brain death was obtained by clinical criteria and either EEG (6 patients) or cerebral angiography (5 patients).
TCD examinations on a daily routine basis offer a noninvasive monitoring method for early assessment of intracranial circulatory arrest. TCD enables quick identification and further diagnosis of candidates for organ transplant donation.
移植医学领域令人鼓舞的成果使得对器官移植供体的需求不断增加。经颅多普勒（TCD）已被多位研究人员用于评估脑死亡患者的脑循环停止情况。我们报告TCD作为早期识别潜在器官移植供体的监测工具。
一项前瞻性临床研究。
奥地利维也纳一家拥有900张床位的社区医院（一级和三级护理中心）的重症监护病房（ICU）。
所有入住我们重症监护病房的急性颅内病变患者每天至少接受一次TCD检查。对于格拉斯哥昏迷评分<7的患者，若TCD波形呈高阻力形态且经降低颅内压的治疗尝试后无变化，则表明需要每天进行多达4次的重复TCD检查。至少两条颅内动脉出现舒张期血流缺失或逆转或早期收缩期小尖峰的TCD波形异常被认为构成颅内循环停止。脑死亡通过临床标准、脑电图（EEG）呈等电位或动脉造影显示脑内动脉未显影来确认。
1994年1月至1996年7月，我们确定了11名昏迷患者为潜在器官移植供体，其典型的TCD表现提示颅内循环停止。诊断为蛛网膜下腔出血7例，脑出血4例。在TCD检查结果提示颅内循环停止后，立即根据奥地利法律标准启动脑死亡诊断。通过临床标准以及EEG（6例患者）或脑血管造影（5例患者）确认脑死亡。
每日进行TCD检查提供了一种非侵入性监测方法，用于早期评估颅内循环停止。TCD能够快速识别并进一步诊断器官移植捐赠候选者。
