儿童脑死亡:发生率、捐献率和中枢性尿崩症的发生

IF 0.9 Q4 CRITICAL CARE MEDICINE Journal of Critical Care Medicine Pub Date : 2018-01-01 DOI:10.2478/jccm-2018-0005
N. Yener, M. Paksu, Ö. Köksoy
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引用次数: 3

摘要

摘要简介:脑死亡目前被定义为包括脑干在内的全部脑功能的丧失。儿科人群的诊断及其后续处理仍然存在争议。本研究的目的是明确脑死亡患者的人口学特征、临床特征和结局,确定儿童脑死亡发生率、捐献率和中枢性尿崩症伴脑死亡的发生率。方法:这项回顾性研究是在土耳其Samsun Ondokuz Mayıs大学医学院的12个床位的三级医疗联合内科和外科儿科重症监护室进行的。341例死亡中有37例(10.8%)被诊断为脑死亡。导致脑死亡的主要原因是心肺骤停8例(21.6%),头部外伤8例(21.6%),溺水4例(18.9%)。所有患者均使用经颅多普勒超声作为辅助检查,并重复检查,直到与脑死亡相一致。结果:在33例(89%)患者中,中枢性尿崩症是在确认脑死亡时或临近时确诊的。未诊断为CDI的4例患者均有急性肾功能衰竭,行肾替代治疗。器官捐献的同意率为18.9%,16.7%的潜在捐献者进行了实际捐献。结论:在目前的研究中,器官捐献的同意率与世界其他地区相比相对较低。小儿脑死亡人群中枢性尿崩症的患病率高于文献报道,在4例脑死亡患者中,急性肾衰竭导致中枢性尿崩症的缺失。需要进一步的研究来解释脑死亡患者的正常尿症。
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Brain Death in Children: Incidence, Donation Rates, and the Occurrence of Central Diabetes Insipidus
Abstract Introduction: Brain death is currently defined as the loss of full brain function including the brainstem. The diagnosis and its subsequent management in the pediatric population are still controversial. The aim of this study was to define the demographic characteristics, clinical features and outcomes of patients with brain death and determine the incidence of brain death, donation rates and occurrence of central diabetes insipidus accompanying brain death in children. Methods: This retrospective study was conducted at a twelve-bed tertiary-care combined medical and surgical pediatric intensive care unit of the Ondokuz Mayıs University Medical School, Samsun, Turkey. In 37 of 341 deaths (10.8%), a diagnosis of brain death was identified. The primary insult causing brain death was post-cardiorespiratory arrest in 8 (21.6%), head trauma in 8 (21.6%), and drowning in 4 (18.9%). In all patients, transcranial Doppler ultra-sound was utilised as an ancillary test and test was repeated until it was consistent with brain death. Results: In 33 (89%) patients, central diabetes insipidus was determined at or near the time brain death was confirmed. The four patients not diagnosed with CDI had acute renal failure, and renal replacement treatment was carried out. The consent rate for organ donation was 18.9%, and 16.7% of potential donors proceeded to actual donation. Conclusion: In the current study the consent rate for organ donation is relatively low compared to the rest of the world. The prevalence of central diabetes insipidus in this pedaitric brain death population is higher than reports in the literature, and acute renal failure accounted for the lack of central diabetes insipidus in four patients with brain death. Further studies are needed to explain normouria in brain-dead patients.
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来源期刊
Journal of Critical Care Medicine
Journal of Critical Care Medicine CRITICAL CARE MEDICINE-
CiteScore
2.00
自引率
9.10%
发文量
21
审稿时长
11 weeks
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