摘要：
目的 观察和统计潜在脑死亡器官捐献供者在器官捐献前出现的异动情况,分析出现异动的影响因素,避免因异动造成误解并导致器官捐献失败.方法 2016年1月至2017年12月期间,前瞻性地收集潜在脑死亡器官捐献供者的相关临床资料.动态记录患者在确诊为脑死亡后的神经系统查体、影像学检查和实验室检查的相关参数.脑死亡后出现肢体、头部和呼吸样运动定义为异动;并通过单因素和多因素分析,筛查与异动出现相关的因素.结果 依据纳入标准,共164例患者纳入研究,22例(13.4％)患者出现异动,持续时间皆小于72 h;其中21例(12.8％)为肢体异动,6例(3.7％)为呼吸样运动,5例(3％)两者皆具;4例(2.4％)出现头部转动,均伴有肢体异动.单因素和多因素分析显示,腋温≤36°C,血Na+≤125 mmol/L,脑干原发伤,自主呼吸停止≤72 h,以及年龄≤18岁与脑死亡患者出现异动相关.结论 脑死亡患者的异动发生率较高,达13.4％,主要表现为肢体异动和呼吸样运动,其发生与“腋温、血Na+水平、脑干原发伤、自主呼吸停止及患者年龄”等因素相关,予以正确的认知和解释有助于器官捐献的成功实施.%Objective By analyzing unusual movements of brain death organ donors before organ donation,to avoid misunderstanding and ensure the implementation of organ donation successfully.Methods Relevant clinical data of potential brain death organ donors admitted to the First Affiliated Hospital of Sun yat-sen University were prospectively collected between January 2016 and December 2017.The related parameters of neurological examination,neuroimaging examination and laboratory examination after brain death determination were dynamically recorded.The occurrence of limb,head and respiratory-like movement after brain death was defined as unusual movements,and the factors associated with unusual movements were screened by univariate and multivariate analysis.Results According to the inclusion criteria,164 patients were enrolled into this study.Twenty-two (13.4％) had unusual movements and duration was less than 72 h.Among them,21 (12.8％) had limbs unusual movements,6 (3.7％) had respiratory-like movement,5 (3％) owned both,and 4 (2.4％) had head rotation accompanied with limbs unusual movements.Univariate and multivariate analysis showed that axillary temperature ≤36 °C,serum sodium ≤125 mmol/L,primary brain stem injury,spontaneous respiratory arrest time ≤72 h and age ≤ 18 years were associated with unusual movements.Conclusion During the clinical practice of brain death determination in China,the incidence of unusual movements is relatively low,and related to some factors,but it is extremely easy to cause misunderstanding.Correct cognition and interpretation are contributed to the successful implementation of organ donation.
