A sutudy ob evaluation of brain death using electrically stimulted auditory veoked potentials and its pathology of temoral bone and brain

对于辅助昏睡患者，听觉短、中、长潜伏期诱发电位(听觉脑干反应（ABR）、中潜伏期反应（MLR）、颞椎反应（SVR）和视觉诱发反应的组合比听觉谷反应（ABR）或颞椎反应（SVR）更全面。73名处于完全昏迷状态的患者接受了观察。42例患者有严重颅脑损伤，其余患者有不同原因的昏迷。入院后两个月内。34名患者存活，39名患者死亡。对康复患者出院后的生活质量进行观察，同时进行热测、3-3-3 -9分级和脑电图记录，比较听觉诱发电位。结果表明，听觉诱发电位分期分类对评估糖尿病患者的生存和脑死亡具有重要意义。对1例脑死亡病例进行了病理研究。经神经学检查、平脑电图记录和听觉诱发反应的持续缺失，证实脑死亡至少48小时。死后3小时进行尸检。整个听道长度的病理研究发现，Corti器官完全自溶，耳蜗背核细胞明显丢失，中央听道其他核细胞中度丢失。在昏迷患者中，如果听性脑干反应缺失，应考虑Corti器官的完全溶解和耳蜗核的分泌性细胞丢失。电刺激听觉诱发电位的研究患者接受耳蜗植入手术。由于人工耳蜗产生的电伪影严重干扰，早期未观察到e - abr，但E-MLR和E-SVR记录较好。此外，还记录了纯音和文字的P300事件相关电位。在这项研究中，E-ABR对脑死亡的临床评估用处不大，但视觉诱发反应被证明是牢固存在的，即使在脑死亡的情况下abr不存在。少

For assissing comatose patints, the combination of audityry short, middle and long latency evoked potentials (auditory brain stem response (ABR), middle latency respones (MLR), and sloe vertez ersponse (SVR) and visual evoked rtesponse in more comprahensive than auditory granstem response (ABR) only or ABR with sloe vertex response (SVR). Seventy-three asutely comatose patients were stauied. Fourty-two of the patients had severe head injury and others had coma of vatied etiology. Within two moonths after asmission. 34 patiens survive, while 39 pariemts died. For comparison with auditory evoked potentials, caloric test, 3-3-9 grading sacle and EEG recording were performed simultaneously and quality of life of recovered cases were investigated after discharge. It was concluded that staging classification of auditory evoked potentials were very useful for assessing comtose patients' life and brain death.A case of brain death was pathologically stuied. Brain death of at least 48 hours' dur … More ation was demonstrated by neurological examination, flat electroencephalographic recording, and persistent absence of auditory evoked responses. The postrmorten examination was performed 3 hours after death. The parthological studies studies of the whole length of the auditory pathway reveled total autolysis of the organ of Corti, marked cell loss in the dorsal cochlear nucleus, and moderate cell loss in other nucle of the central auditory pathway. It should be considered that total antolysis of the organ of Corti and secere cell loss of the cochlear nucleus may occur if the auditory brain stem response becomes absent in comatose patients.Electrically stimulated auditory evoked potentials were studied for patinets who underwent cochelar implant surgery. E-ABRs were not observed in the early componets becasuse of setious interfere of electrical artifacts from cochlear implant device but E-MLR and E-SVR were well recorded. In addition, event related potentials of P300 for pure tone and words wrte recorded. In this study E-ABR was recvealed to br less useful for clinical evaluation of brain death but visual evoked response was demonstrated to be toughly present even if ABRs were sbaent in the condition of brain death. Less