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进行了咖啡因含量测定。使用气相色谱/质谱法测定人体组织中的咖啡因浓度。使用组织-血液浓度比评价每种情况下的分布模式。在非脑死亡病例中，各组织中的比值稳定，除脂肪组织中的比值接近0.3外，其他组织中的比值均接近1。在脑死亡病例中，除脑和脂肪外的所有组织中的比值与非脑死亡病例中的比值相似。脑死亡组中有5例脑死亡患者脑内的上述比值高于非脑死亡组，1例脑死亡患者在医院输血后脑内上述比值低于非脑死亡组。脂肪中的比值略高于非脑死亡病例。脑死亡病例中这些不协调的分布可能与血液循环停止有关， ...更多信息 在脑死亡的时候大脑中有一个因此，比较脑组织与其他组织中咖啡因的浓度，有助于脑死亡的法医学诊断。我们研究了一位49岁脑死亡患者的药物分布，目的是确定诊断患者如何以及何时脑死亡的可能性。采用气相色谱-质谱联用技术，证实了甲哌卡因、喷他佐辛、利多卡因和甲硫氨酸在包括7个脑区在内的各种组织中的存在。大脑中甲哌卡因、喷他佐辛和利多卡因的组织与血液浓度比高于其他组织中的组织与血液浓度比，而甲硫苯丙胺的浓度比较低。因此，与临床记录一致，在前一种药物和后一种药物给药之间，脑血流可能已经停止。在7个脑区中，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。另一方面，后一种药物在小脑和延髓中的比例较高。因此，脑血流在枕叶和顶叶停止较快，在小脑和延髓停止较晚。基于这些结果，评估药物在人体组织（包括脑的各个区域）中的结合对于确定脑死亡的时间和进展是有用的。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