潜在脑死亡后器官捐献供者脑死亡判定中脑电与脑血流"分离现象"的相关因素分析

目的明确脑死亡判定确认检查中脑电与脑血流"分离现象"的影响因素,加强对该现象的了解及认知。方法前瞻性收集中山大学附属第一医院神经外科及重症医学科自2018年6月至2019年5月收治的127例潜在脑死亡后器官捐献(DBD)供者的相关临床资料。所有患者首选脑电和脑血流评估作为脑死亡判定的确认检查方式,对存在"分离现象"的患者,进一步行正中神经短潜伏期诱发电位检查或等待24 h再次进行脑电和脑血流评估以确诊。选择性别、年龄、进行确认检查时自主呼吸停止时间、血压、手术方式、神经查体、神经影像学指标和血Na+等15个参数,通过单因素和多因素Logistic回归分析,明确与"分离现象"相关的危险因素。结果127例患者中,22例(17.3%)存在"分离现象",其中17例(77.2%)脑电静息早于脑血流终止,5例(22.7%)脑血流终止早于脑电静息。多因素Logstic分析结果显示,患者年龄≤14岁(OR=6.250,95%CI:1.201~32.220,P=0.028)、检查时收缩压≥140 mmHg(OR=7.430,95%CI:1.621~33.992,P=0.010)、原发性脑干损伤(OR=15.890,95%CI:3.042~82.930,P=0.006)、自主呼吸停止时间≤72 h(OR=11.964,95%CI:3.045~82.932,P=0.006)及去骨瓣减压术(单侧/双侧)(OR=16.281,95%CI:1.590~89.785,P=0.001)是"分离现象"的独立危险因素。结论"分离现象"在中国脑死亡判定的确认检查中常见,≤14岁患者、检查时收缩压≥140 mmHg、原发性脑干损伤、自主呼吸停止时间≤72 h和行去骨瓣减压手术(单侧/双侧)患者更易出现"分离现象"。

Relative factors for"incongruent phenomenon"of brain electrical activity and cerebral blood flow during brain death determination for potential organ donors

Objective To identify the relative factors for"incongruent phenomenon"of brain electrical activity and cerebral blood flow during brain death determination for potential organ donors,and intensify the understanding and cognition of this phenomenon.Methods The clinical data of 127 potential donors accepted donation after brain death(DBD),admitted to our hospital from June 2018 to May 2019,were collected prospectively.All patients preferred brain electrical activity and cerebral blood flow assessments as the confirmatory tests of brain death determination.For patients with"incongruent phenomenon",further test of median nerve short latency evoked potential or brain electrical activity and cerebral blood flow assessments after waiting for 24 h were performed to confirm brain death determination again.Fifteen parameters,such as gender,age,time of spontaneous respiration arrest,blood pressure,operative types,neurological examination,neuroimaging index,and serum Na+level,were selected;univariate and multivariate Logistic regression analyses were used to identify these risk factors related to"incongruent phenomenon".Results Among the 127 patients,22 patients(17.3%)appeared"incongruent phenomenon";17(77.2%)had electrical silence earlier than cerebral blood flow arrest,and 5(22.7%)had cerebral blood flow arrest earlier than electrical silence.Multivariate Logistic analysis showed that age≤14 years(OR=6.250,95CI:1.201-32.220,P=0.028),systolic blood pressure≥140 mmHg(OR=7.430,95CI:1.621-33.992,P=0.010),primary brain-stem injury(OR=15.890,95CI:3.042-82.930,P=0.006),spontaneous respiratory arrest time≤72 h(OR=11.964,95CI:3.045-82.932,P=0.006),and unilateral/bilateral decompressive craniectomy(OR=16.281,95CI:1.590-89.785,P=0.001)were independent risk factors for"incongruent phenomenon".Conclusion"Incongruent phenomenon"is common in confirmatory test of brain death determination in China;patients with age≤14 years,systolic blood pressure≥140 mmHg,primary brain-stem injury,spontaneous respiratory arrest time≤72 h,and decompressive craniectomy(unilateral/bilateral)are more likely to have"incongruent phenomenon".