Brain death diagnosed by forensic analgsis of drug distribution in human tissues

为诊断脑死亡，对6例脑死亡患者和5例非脑死亡患者的人体组织中咖啡因浓度进行了检测。用气相色谱/质谱仪测定人体组织中咖啡因的浓度。使用组织与血液浓度比来评估每个病例的分布模式。在非脑死亡病例中，各组织的比值均比较稳定，除脂肪外，其余组织的比值均接近1，接近0.3。在脑死亡病例中，除脑和脂肪外的所有组织中的比例与非脑死亡病例相似。脑内比例高于非脑死亡病例，5例脑死亡病例，1例在医院输血的脑死亡病例。脂肪中的比例略高于非脑死亡病例。这些不协调的分布在脑死亡病例中可能与血液循环停止…有关。在脑死亡时的大脑中有更多的信息。因此，将大脑中的咖啡因浓度与其他组织中的咖啡因浓度进行比较，有助于脑死亡的法医诊断。我们检查了一名49岁脑死亡男子的药物分布情况。我们的目标是确定诊断患者如何以及在什么时候脑死亡的可能性。用气相色谱-质谱法证实甲哌卡因、五唑卡因、利多卡因和硫代戊醛在包括大脑7个区域在内的不同组织中的存在。脑组织中甲哌卡因、五唑卡因和利多卡因的组织血药浓度比高于其他组织，而硫代戊醛的组织血药浓度比较低。因此，前一种药物和后一种药物之间的脑血流可能已经停止，这与临床记录一致。在大脑的7个区域中，前3种药物在枕叶和顶叶的比例较高，在小脑和延髓的比例较低。而后一种药物在小脑和延髓的比例较高。因此，大脑血流可能在枕叶和顶叶迅速停止，最后在小脑和延髓停止。根据这些结果，评估药物在人体组织中的浓度，包括大脑的不同区域，有助于确定脑死亡的时间和进展。较少

ln order to diagnose the brain death, caffeine cmcentrations in human tissues of 6 brain death cases as well as 5 non-brain death cases were examined. Concentrations of caffeine in human tissues were determined using gas chromatography/mass spectrometry. The tissue-to-blood concentration ratios were used to evaluate the distribution pattern in each case. In non-brain death cases, the ratios in every tissue were stable, and the values were close to 1 in all tissues except adipose, of which value was near 0.3. In brain death cases, the ratios in all tissues except brain and adipose were similar to those in non-brain death cases. The ratios in the brain were higher than those of non-brain death cases, in 5 brain-death cases, and lower in 1 brain-death case where blood transfusion wes done in a hospital. The ratios in the adipose were slightly higher than those in non-brain death cases. These discorded distribution in the brain death cases was likely related to cessation of blood circulati … More on in the brain at the time of brain death. Therefore, comparing caffelne concentrations in the brain with those in the other tissues were useful for the forensic diagnosis of brain death. We examined the distribution of drugs in a 49-year-old brain-dead man. Our objective was to determine the possibility of diagnosing how and at what point the patient became brain dead. The presence of mepivacaine, pentazocine, lidocaine and thiamylal in various tissues, including 7 regions of the brain were confirmed, using gas chromatography-mass spectromefry. Tissue-to-blood concentration ratios of mepivacaine, pentazocine and lidocaine in the brain were higher than theseratios in other tissues, while ratios of thiamylal were lower. Therefore, cerebral blood flow was likely to have ceased between the administration of the former drugs and that of the latter drug, in agreement with clinical records. Among 7 regions of the brain, the ratios of the former 3 drugs were high in occipital and parietal lobes, and were low in the cerebellum and meduua oblongata. On the other hand, the ratios of the latter drug were high in the cerebellum and the medulla oblongata. Therefore, cerebral blood flow presumably ceased fast in occipital and parietal lobes, and last in the cerebellum and he medulla oblongata. Based on these results, assessment of concoitrations of drugs in human tissues, Including various regions of brain is useful to determine the time and progression of brain death. Less