Glasgow昏迷量表评分3分的昏迷患儿脑死亡判定分析

摘要

Objective To summarize the clinical features and technical key points on brain death during decision-made process in children with suspected brain death.Methods Twenty-four coma children with Glasgow coma scale score 3 and no spontaneous respiration were collected from May 2015 to February 2017 in Beijing Children's Hospital,Capital Medical University to make the brain death determination.All children received at least one confirmatory test.According to the Chinese standards for determining brain death (pediatric),all patients were divided into brain death group and non-compliance group.The clinical features were analyzed.The sensitivity,specificity,false positive rate and false negative rate of electroencephalogram (EEG),short latency somatosensory evoked potential (SLSEP) and transcranial Doppler sonography (TCD) were calculated.Results Among these 24 cases,there were 16 males and 8 females,aged 5.6 (2.0,8.8) years old.Ten cases met the criteria of brain death.Twelve (50％,12/24 cases) cases received autonomic breathing test.A total of 25 tests were conducted,of which 21 were successful.The completion rates of EEG,TCD and SLSEP were 100.0％ (24/24 cases),83.3 ％ (20/24 cases) and 54.2％ (13/24 cases),respectively.EEG had the highest sensitivity (100％) and specificity (79％).SLSEP had good sensitivity (100％),but the specificity was only 40％.The combination of EEG with SLSEP had the highest specificity and sensitivity,both of which were 100％,and the false positive rate and false negative rate were 0.Conclusions The key to determine brain death successfully is to make adequate preparations,to receive formal training and to apply standard operation.In the determination of brain death in children,EEG has a good sensitivity and specificity in single confirmation test,which is the priority item.The combination of EEG with SLSEP is the most advantageous.%目的 总结临床疑似脑死亡患儿在脑死亡判定过程中的临床特点和技术要点.方法 对2015年5月至2017年2月首都医科大学附属北京儿童医院收治的24例Glasgow昏迷量表评分为3分且自主呼吸消失的患儿进行脑死亡判定,所有患儿均接受至少1项确认试验.根据中国儿童脑死亡判定标准分为脑死亡达标组和未达标组,分析其临床判定特点,计算脑电图(EEG)、短潜伏期体感诱发电位(SLSEP)、经颅多普勒超声(TCD)的灵敏度、特异度、假阳性率和假阴性率.结果 24例患儿中男16例,女8例;年龄5.6(2.0,8.8)岁,其中10例完全符合脑死亡判定标准.12例(50％,12/24例)患儿进行了自主呼吸激发试验,共25人次,成功21人次.EEG、TCD和SLSEP的完成率分别为100.0％(24/24例)、83.3％(20/24例)和54.2％(13/24例);其中EEG灵敏度(100％)和特异度(79％)最高;SLSEP灵敏度为100％,特异度仅为40％.EEG与SLSEP组合时特异度、灵敏度最高,均为100％,且假阳性率和假阴性率均为0.结论 做好脑死亡判定前的准备工作、接受正规专业培训及规范操作是正确判定脑死亡的关键.儿童脑死亡判定时,单项确认试验中EEG有良好的灵敏度和特异度,为优选项目;确认试验组合时以SLSEP和EEG最具优势.