摘要
目的2019年5月由国家卫生健康委员会脑损伤质控评价中心修订的2018版《中国儿童脑死亡判定标准与操作规范》发布,使我国儿童脑死亡判定工作更为规范、有序。然而,目前我国缺少体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)高级生命支持治疗下实施上述脑死亡判定标准的指引。对我院PICU 1例动-静脉体外膜肺氧合(VA-ECMO)治疗下的重症脑损伤并肺出血患儿成功完成了脑死亡判定及器官移植(供体),为我国儿童脑死亡判定指南的修订提供临床参考。方法我们参考2020年8月JAMA发表的脑死亡判定国际指南,对我院PICU 1例VA-ECMO(血流量720~750 mL/min,气流量600 mL/min,氧浓度65%~70%)治疗下的重症脑损伤并肺出血患儿进行脑死亡判定。结果脑死亡判定结果包括:格拉斯哥昏迷评分2T,所有脑干反射消失,三项确认试验(脑电图、经颅多普勒超声、短潜伏期体感诱发电位)均符合脑死亡判定标准,自主呼吸激发试验(apnea test,AT)PaCO_(2)>60 mmHg(1 mmHg=0.133 kPa)且较AT前升高幅度>20 mmHg。先后共进行了2次脑死亡判定,间隔时间>12 h。最终成功完成了该病例的脑死亡判定及器官移植(供体)。结论这例VA-ECMO下肺出血儿童脑死亡判定的成功经验,可为我国儿童脑死亡判定指南的修订提供临床参考。
Objective In May 2019,the 2018 version of Criteria and practical guidance for determination of brain death in children in China was published,which was revised by Brain Injury Evaluation Quality Control Center of National Health Commission,making the determination of brain death for pediatric patients in China more standardized and orderly.However,there is currently lacking of direction for the implementation of the above criteria for determining brain death to patients supported on extracorporeal membrane oxygenation(ECMO)in China.We successfully completed the determination of brain death and the organ transplantation(as a donor)for a pediatric case with severe brain injury and pneumorrhagia supported by VA-ECMO in our PICU,which provided clinical references for the revision of the guidelines for determination of brain death for pediatric patients in China.Methods By referring to the international guidelines of Determination of Brain Death/Death by Neurologic Criteria:The World Brain Death Project published in JAMA in August 2020,we performed a determination of brain death for a case of pediatric patient with severe brain injury and pneumorrhagia supported by VA-ECMO(blood flow 720 to 750 ml/min,gas flow 600 mL/min,oxygen concentration 65%to 70%)in our PICU.Results The results of the determination of brain death included:Glasgow coma scale was 2T,all brainstem reflexes disappeared,three confirmation tests(electroencephalography,transcranial Doppler,short latency somatosensory evoked potential)all met the criterias for determination of brain death,apnea test(AT)showed PaCO2>60 mmHg and elevated>20 mmHg than that before AT.We performed twice determination of brain death,interval time was>12 h.Finally,we successfully completed the determination of brain death and the organ transplantation(as a donor)for the case.Conclusion The successful experience in the determination of brain death in the pediatric patient with severe brain injury and pneumorrhagia supported by VA-ECMO will provide clinical references for the rev
作者
司徒勋
张剑珲
吴艳兰
黎明
林海洋
陶建平
Situ Xun;Zhang Jianhui;Wu Yanlan;Li Ming;Lin Haiyang;Tao Jianping(PICU,Guangzhou Women and Children′s Medical Center,Guangzhou 510623,China)
出处
《中国小儿急救医学》
CAS
2021年第12期1054-1059,共6页
Chinese Pediatric Emergency Medicine
关键词
体外膜肺氧合
脑死亡
自主呼吸激发试验
肺出血
儿童
Extracorporeal membrane oxygenation
Brain death
Apnea test
Pneumorrhagia
Children
