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目的就如下问题对美国神经病学会1995年脑死亡判定实践标准进行更新:①符合脑死亡临床判定标准的患者神经功能能恢复吗?②确定患者神经功能永久性停止的恰当观察时间是多长?③有时可能观察到脑死亡患者的复合肢体运动,这是否错误地提示仍然保留脑功能?④何种技术手段判断呼吸停止是相对安全的?⑤是否存在新的辅助检测能准确判断患者脑死亡?方法系统回顾MEDLINE及EMBASE数据库1996年1月—2009年5月收录的文献,其研究仅限于成年人(≥18岁)。结果及建议对成年人,按照美国神经病学会于1995年确定的脑死亡判定实践标准,目前尚无判定为脑死亡患者出现神经功能恢复的报告。脑死亡患者可以存在复合的自发运动及假阳性触发呼吸机。目前还无足够的证据用以确定神经功能不可逆性停止的最短观察时间。通过氧扩散来确定呼吸停止是安全的,但目前还无足够证据确定呼吸停止检测技术的相对安全性。目前还无足够的证据确定新型辅助检测能否准确判断患者全脑功能已经停止。
OBJECTIVE To update the criteria of brain death judgment in 1995 by the American College of Neurology on the following questions: (1) Can neurological function recover in patients meeting the clinical criteria of brain death? (2) What is the appropriate observation time to determine the permanent halt of neurological function? Is it wrong to suggest that brain function is still retained? ④ Which technique is used to determine whether respiratory arrest is relatively safe? ⑤ Is there any new auxiliary test that can accurately determine the brain death in patients? Methods System review MEDLINE and EMBASE database The literature, January 1996-May 2009, is limited to adults (≥18 years of age). RESULTS AND RECOMMENDATIONS There is no report of adult neuropsychiatric outcome in adults judged to have been judged by the American College of Neurology as a practice standard for brain death determination in 1995. Patients with brain-dead may have combined spontaneous motor activity and false positive triggering ventilator. There is still not enough evidence to determine the shortest observation time for the irreversible cessation of neurological function. It is safe to determine respiratory arrest by oxygen diffusion, but there is not enough evidence to establish the relative safety of respiratory arrest testing techniques. There is not enough evidence to determine whether a new ancillary test can accurately determine whether a patient’s whole brain function has stopped.