Transcranial Doppler ultrasound in brain death: experience in 140 patients.
Transcranial Doppler ultrasound in brain death: experience in 140 patients.
复制标题
经颅多普勒超声治疗脑死亡：140 名患者的经验。
作者：
Yvonne Zurynski;Nicholas W. C. Dorsch;I. Pearson;R. Choong
对脑死亡的临床测试的解释通常因面部创伤的存在或使用巴比妥酸盐治疗来降低颅内压而复杂化。我们提出了一种非侵入性技术--经颅多普勒(TCD)超声诊断脑死亡。140名昏迷患者接受了经颅多普勒检查，其中111人被认为是脑死亡。在进行脑死亡的正式临床检测之前，对大脑中动脉(MCAS)和基底动脉进行TCD评估。脑死亡(BD)患者记录的TCD频谱包括短而尖锐的收缩峰，然后在舒张期出现逆行血流，或仅有收缩峰在两个方向上都没有血流。在显示这两种TCD模式的患者中，没有幸存者。29名昏迷的对照组患者在整个心脏周期中始终显示血流--这些患者中没有记录到逆行血流，所有患者都存活了下来。尤其令人感兴趣的是基底动脉的结果。9例BD患者均未显示大脑中动脉信号，但记录到高质量的基底动脉信号。TCD检查结果与临床及四支脑血管造影结果基本符合。本文阐述了经颅多普勒超声检查大脑中动脉，特别是基底动脉在脑死亡诊断中的作用。
The interpretation of clinical tests for brain death is often complicated by the presence of facial trauma, or the use of barbiturate therapy for reduction of intracranial pressure. We propose a non-invasive technique--transcranial Doppler (TCD) sonography for the diagnosis of brain death. One hundred and forty comatose patients, 111 of whom were believed to be brain dead underwent TCD examinations. TCD assessments of the middle cerebral arteries (MCAs) and the basilar artery were performed before formal clinical testing for brain death. The TCD spectra recorded in the brain dead (BD) patients consisted of short, sharp systolic peaks followed by retrograde flow during diastole or just systolic peaks with absent flow in either direction. There were no survivors among patients who displayed these two TCD patterns. The 29 comatose control patients always showed flow throughout the cardiac cycle--no retrograde flow was ever recorded in these patients all of whom survived. Of particular interest were the basilar artery results. In nine BD patients no MCA signals could be obtained while good quality signals were recorded from the basilar artery. The TCD results agreed essentially with 100% accuracy with clinical testing and four vessel cerebral angiography. This paper illustrates the usefulness of TCD examination of the MCAs and especially the basilar artery in the diagnosis of brain death.