脑电图在脑死亡判定中的应用  

Role of electroencephalogram in the brain death diagnosis

作　　者：徐珂 徐光锦 唐娜 刘晓艳[1] 朱文浩[1] 朱遂强[1] 王芙蓉 Xu Ke;Xu Guangjin;Tang Na;Liu Xiaoyan;Zhu Wenhao;Zhu Suiqiang;Wang Furong(Department of Neurology,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属同济医院神经内科,武汉430022

出　　处：《中华器官移植杂志》2020年第11期677-680,共4页Chinese Journal of Organ Transplantation

基　　金：2019湖北省技术创新专项重大项目(2019ACA132);国家科技基础资源调查专项(2018FY100900);华中科技大学自主创新基金(540-5003540062,540-5003540083)。

摘　　要：目的评价脑电图在脑死亡判定中的应用价值。方法回顾性收集华中科技大学同济医学院附属同济医院2015年12月至2019年7月申请脑死亡判定的患者信息、临床资料和辅助检查结果。脑死亡的临床判定必须由2名以上具有判定资质的医师执行。而辅助检查则包括脑电图(electroencephalogram, EEG)、经颅多普勒超声(transcranial Doppler, TCD)、短潜伏期体感诱发电位(short-latency somatosensory evoked potential, SLSEP)。判定标准参照中国的成人及儿童脑死判定指南。结果共收集77例患者信息,其中符合脑死亡诊断标准的患者共72例,年龄(42±5)岁(8~67岁),EEG的完成率为96.4%。13.9%脑死亡患者EEG存在头皮肌电伪差,使用肌松剂后EEG呈电静息状态。在脑死亡判定中,EEG的敏感性为95.8%。出现1例假阳性病例,但EEG仍预测了患者最终的死亡,可能与EEG不能显示脑干的电活动有关。结论 EEG在脑死亡判定中具有良好的敏感性。头皮肌电伪差在脑死亡患者EEG中并不少见,必要时可使用肌松剂辅助判定。Objective To evaluate the application value of electroencephalogram(EEG)in diagnosing brain death.Methods From December 2015 to July 2019,basic profiles,clinical data and ancillary examinations were collected retrospectively for patients applying for brain death determination.Clinical test of brain death had to be performed by at least two qualified physicians.Ancillary examinations included electroencephalogram(EEG),transcranial Doppler ultrasonography(TCD)and short-latency somatosensory evoked potential(SI SEP).The diagnostic criteria were based upon the Chinese Guidelines for Determining Brain Death in Adults and Children,Results Among a total of 77 patients,72 of them fulfilled the diagnostic criteria for brain death.The average age was(42±5)(8-67)years and the completion rate of EEG 96.4%.And 13.9%of brain-dead patients demonstrated electromyographic artifact and EEG hinted at electrocerebral inactivity after using muscle relaxants.The diagnostic sensitivity of EEG was 95.8%in brain death.For one false positive case,EEG still predicted the patient's eventual mortality possibly due to the inability of EEG to show electrical activity in brain stem,Conclusions EEG has an excellent sensitivity in brain death determination.Scalp electromyography artifact is not uncommon on EEG of brain-dead patients.And muscle relaxants may aid the determination process if necessary.

关 键 词：脑死亡 脑电图 诊断 

分 类 号：R741.044[医药卫生—神经病学与精神病学]