儿童体外膜肺支持下脑死亡判定  

Determination of brain death in child patients on extracorporeal membrane oxygenation

作　　者：黄慧敏[1] 王静 李易娟[1] 郭予雄[2] 徐桂兴[3] 唐雯[1] 梁玉坚[1] HUANG Huimin;WANG Jing;LI Yijuan;GUO Yuxiong;XU Guixing;TANG Wen;LIANG Yujian(Department of Pediatric Intensive Care Unit,the First Affiliated Hospital of Sun Yat-sen University,Zhongshan second Road,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院儿科ICU,广州510080 [2]广东省人民医院PICU [3]中山大学附属第一医院神经外科

出　　处：《中国神经精神疾病杂志》2022年第11期664-669,共6页Chinese Journal of Nervous and Mental Diseases

基　　金：2021年广东省医学科学技术研究基金项目科学研究专项(编号:A2021327)。

摘　　要：目的探讨体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)支持下重症儿童脑死亡判定方法。方法通过报告两个中心3例ECMO支持下重症患儿脑死亡判定实施过程,总结目前国内外文献报告的案例经验。结果3例患儿在临床判断为脑死亡和完成确认试验后,通过撤离呼吸机和逐步下调气流量方法进行自主呼吸激发试验的判定,患儿均确认脑死亡。结论通过逐渐下调气流量方法在ECMO下进行儿童脑死亡的自主呼吸激发试验安全可行,为我国儿童脑死亡判定的安全实施做出探索。Objective Apnea tests in the determination of brain death in child patients on extracorporeal membrane oxygenation(ECMO)remain challenges.The study aimed at exploring an implementation method of apnea test in those patients.Methods A total of 3 pediatric cases supported by venous-arterial ECMO in two tertiary care PICUs underwent evaluation of brain death.After neurologic examinations demonstrated cessation of brain function in accordance with brain death guidelines,apnea testing was performed on each child on ECMO.Meanwhile,literature reviews were conducted to summarize relevant experience on apnea test.Results The three children suffered with drowning,gas poisoning or congenital heart disease respectively.After clinically judged as brain death,they were assessed by four qualified doctors two times.The apnea test was conducted by withdrawing the ventilator and gradually reducing sweep gas flow rate.The process was safe,and those children were finally confirmed to be brain-dead.Conclusion Determination of brain death under ECMO remains challenging in children.Apnea test is the key part in the determination of brain death.It is safe and feasible to conduct apnea test for children on ECMO by gradually reducing sweep gas flow rate.

关 键 词：脑死亡 体外膜肺氧合 自主呼吸激发试验 儿童 机械通气 实施方法 

分 类 号：R741[医药卫生—神经病学与精神病学]