摘要
目的 以儿童脑死亡标准为参考,通过诊断新生儿脑死亡病例分析,总结新生儿脑死亡的特点.方法 报道1例新生儿脑死亡的病例并复习汇总新生儿脑死亡文献.结果 患儿,男,胎龄39＋4周,阴道分娩出生,出生体重3 370 g.生后无呼吸和心跳,生后Apgar评分1、5、10和15 min分别为1、2、2和2分.20 min后心跳恢复,叹气样呼吸.生后2h转运至复旦大学附属儿科医院,仍呈昏迷状态,依赖机械通气,双侧瞳孔散大,对光反射和原始反射消失.血气分析提示严重代谢性酸中毒,间隔12 h的2次扩容后血压稳定.可自主排尿,尿量正常.每天行神经功能评估始终处于昏迷中,无自主呼吸,肌张力和肌力严重低下,各种原始反射不能引出,双侧瞳孔散大,对光反射、咳嗽反射和角膜反射均消失.予振幅整合脑电图（aEEG）连续监测4d电压均＜2 μV,入院后5d脑干听觉诱发电位（BAER）、体感诱发电位、视觉诱发电位均不能引出.入院后6和12 d视频脑电图均提示＜2 μV静息电压.入院后13和14 d行脑血流监测,提示大脑前、中、后动脉轻中度痉挛.入院后13 d头颅CT提示双侧大脑弥漫性低密度影,脑室扩大.自主呼吸激发试验进行了7 min,因严重心率减慢而终止.结合脑电图诊断脑死亡.以“brain death”AND“newborn”OR“neonatal”OR“neonate”在PubMed数据库共检索到28例新生儿脑死亡病例,结合本文的1例,29例新生儿脑死亡病例,早产儿8例（化脓性脑膜炎2例,严重脑室内出血5例,胎母输血1例）;脑死亡确诊日龄为入院后2～7d,脑死亡的观察期2～9d;足月儿21例（重度窒息11例,婴儿猝死综合征4例,严重感染3例,严重颅内出血2例,戒断综合征1例）;脑死亡确诊日龄为入院后1～6d,脑死亡的观察期1 ～73 d.新生儿脑死亡临床诊断均达到以下标准：昏迷,对各种刺激无反应;脑干功能丧失,主要评估方法为瞳孔扩大,对光反射、角膜反射和眼脑反射�
Objective According to the criterion of brain death （BD）for chihlren, through the diagnosis of neonatal BI） cases analysis to summarize the characteristics of the neonatal BD. Methods One case of neonatal BD was reported and the literatures about neonatal BD were reviewed. Results A 39 ＋4 weeks gestational age male was delivered spontaneously and birth weight was 3 370g. He was apnea, hypotonic, unresponsive and without pulse or heart sound on auscultation ＂after birth. Advanced cardiopulmonary resuscitation was performed. Apgar score at 1, 5, 10 and 15 rain was 1, 2, 2, and 2, respectively . He regained spontaneous circulation and sigh breath after 20 min. The first neurological exam showed coma, large bilateral pupils aml unresponsive to light, no primitive reflex, marked hypotonic and dependent on mechanical ventilation 2 h afJer birth when transferred to our NICU. The same findings repeated during hospital stay. The blood gas showed severe metabolic acidosis which was corrected by bicarbonate infusion 24 h later. The blood pressure was stable by fluid resuscitation and inotropic support, aEEG was continuously monitored and showed a silent background activity pattern for 4 d. BAER, SEP and VEP could not be drawn outat d5. The video EEG showed electrocortical silence at d6 and d12. TCD at d13 and d14 showed bilateral low peak systolic velocities. 13 d after admission the CT scan showed bilateral cerebral diffuse low density, ventricle enlargement. Spontaneous breathing test was terminated 7 min late due to severe slow heart rate. The diagnosis of BD was done according neurological exam and the EEG result. Searching on PubMed as the ＂brain death＂ and ＂Newborn＂ OR ＂neonatal＂ OR ＂neonate＂ ,29 neonatal BD cases were retrieved. The causes of BD for 8 premature babies were the meningitis （2 cases） , severe intraventricular hemorrhage （ 5 cases） and maternal-fetal blood transfusion （ 1 case） ; BD was confirmed 2 - 7 d after admission and observation period was 2 - 9 d; The causes
出处
《中国循证儿科杂志》
CSCD
北大核心
2015年第2期114-118,共5页
Chinese Journal of Evidence Based Pediatrics
关键词
新生儿
脑死亡
窒息
振幅整合脑电图
Newborn
Brain death
Asphyxia
Amplitude-integrated EEG
