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To confirm the usefulness of N18 and other SEP components of medullary origin for the diagnosis of brain death

确认 N18 和其他髓质来源的 SEP 成分在诊断脑死亡中的有用性

基本信息

批准号：
09670669
负责人：
SONOO Masahiro
金额：
$ 1.98万
依托单位：
Teikyo University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
1997
资助国家：
日本
起止时间：
1997 至 1999
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-09670669/
关键词：
somatosensory evoked potentials (SEPs)median nerve brain death criteria to diagnose brain death N18 auditory brainstem responses (ABRs)brainstem function cuneate nucleus in medulla oblongata 脳幹機能 P13 14電位 P9電位

项目摘要

1. We collected around 140 recordings of SEP and ABR together with clinical signs from around 100 brain-dead or comatous patients during the 3 years we accepted the grants. As a result, N18 in median SEPs was lost in all the brain-dead recordings whereas it was preserved in nearly 90% of comatous but not brain-dead recordings. Namely, N18 had perfect specificity and very high sensitivity (higher than ABR which was preserved for about 80% of comatous recordings) for detecting the remaining brainstem function.2. We managed to follow the course progressing from coma to brain-death in 8 patients having brain herniation. Signs reflecting midbrain function such as light reflex and oculocephalic reflex were first lost, those reflecting pontine function such as corneal reflex and wave III in ABR followed. Lastly, loss of cough reflex and pharyngeal reflex, cease of spontaneous respiration, sudden fall of blood pressure and loss of N18 occurred within a short time and brain-death was judged to be established. The fact that N18 disappeared concomitantly with these signs reflecting medullary functions further supported our opinion that N18 is generated by the cuneate nucleus located in the medulla oblongata.3. There has been no neurophysiological or other method which can objectively evaluate the function of medulla oblongata which plays the most important role for maintaining the vital functions. ABR can evaluate only pontine and midbrain functions. The present investigation established N18 as the first objective indicator for the medullary function. Wide clinical application of N18 must increase the reliablity of the diagnose is of brain death.4. Other related researches performed include: the origin of the P13-like potential which remains after brain death (by Sonoo), the origin of P9 (by Mochizuki and Sonoo) and the best method to determine the stimulus intensity in median SEPs (by Fukuda and Sonoo).

1. 在我们接受资助的3年中，我们收集了大约140份SEP和ABR记录以及大约100名脑死亡或昏迷患者的临床体征。结果，在所有脑死亡记录中，中位sep中的N18都丢失了，而在近90%的昏迷记录中保留了N18，但在脑死亡记录中没有。即N18对于检测脑干剩余功能具有完美的特异性和非常高的灵敏度（高于ABR， ABR保留了约80%的昏迷记录）。我们成功地跟踪了8例脑疝患者从昏迷到脑死亡的过程。反映中脑功能的征象如光反射、眼头反射等首先消失，反映桥脑功能的征象如角膜反射、ABR波III等紧随其后。最后短时间内出现咳嗽、咽反射丧失、自主呼吸停止、血压突然下降、N18丧失，判定脑死亡。N18与这些反映髓质功能的迹象同时消失，进一步支持了我们的观点，即N18是由位于延髓的楔形核产生的。延髓在维持机体生命功能中起着至关重要的作用，目前尚无神经生理学或其他方法能客观评价延髓的功能。ABR只能评价脑桥和中脑功能。本研究确立了N18作为髓质功能的第一个客观指标。N18的广泛临床应用必须提高脑死亡诊断的可靠性。其他相关研究包括：脑死亡后残留的p13样电位的起源（Sonoo）， P9的起源（Mochizuki和Sonoo），确定中位sep刺激强度的最佳方法（Fukuda和Sonoo）。