| Abjective:Brain death is an irreversible state of completely loss of whole brain function which including the brain stem.It is significantly to diagnose the brain death quickly and accurately.The TCD,SLESP and EEG are of great value in the diagnosis of brain death as auxiliary technology.The purpose of this study is to explore the diagnostic value of the diagnosis of brain death in the diagnosis of brain death by using the combined application of the TCD,SLESP and EEG to the patients with severe head injury in clinical practice.Research methods:Method One:80 cases of severe brain injury patients admitted to the Neurotrauma surgery of the First Hospital of Jilin University from January 2017 to November 2018,were selected.At first,they were all passed the clinical brain death diagnosis.There were 33 male cases and 7female cases,with an average age of 46±13,for ages 5 to 65.Patients were divided into supratentorial group(group A,n=54)and subtentorial group(group B,n=26)according to the location of primary lesions.Allof them were examined with TCD,SLSEP and EEG.Brain death would confirmed by two kinds of result up to the standard of brain death diagnosis.And it was considered that the first brain death determination was passed.In this study,only the results of the first determination of brain death were discussed.Cases were sorted out according to the results of different assistive technologies,and the differences in the passing rates of the two groups of patients with different assistive technologies were compared.Method Two: 50 cases of severe brain injury patients,who passed the clinical brain death diagnosis,admitted to the Neurotrauma surgery of the First Hospital of Jilin University from January 2017 to December2017 were selected for this research.There were 41 male cases and 9female cases,with an average age of 49±7,for ages 31 to 62.Patients were divided into disc electrode group and needle electrode group.Each group included 25 patients.The differences of setting time and impedance between electroencephalogram disc electrode and needle electrode in brain death diagnosis were compared.Counting data were expressed as constituent ratio,and chi-square test was used for comparison between groups.The measurement data were expressed as average±standard deviation(x ±s),and independent sample t test was used for comparison between groups.To investigate the role of EEG needle electrode in brain death determination confirmationtest.Results:(1)Among the 80 patients,who met the clinical criteria for brain death,selected in method 1,54 were in the supratentorial group.They included 2 patients with open craniocerebral injury,12 patients with cerebral contusion and laceration,18 patients with epidural and subdural hematoma,6 patients with subarachnoid hemorrhage,and 16 patients with basal ganglia cerebral hemorrhage.The supratentorial group included 26 patients,Including 1 patient with posterior fossa epidural hematoma,6patients with cerebellar contusion and cerebellar hemorrhage,and 19 patients with brainstem hemorrhage.In the TCD judgment results,50 cases were passed in the supratentorial group,with a passing rate of92.6%,and 16 cases were passed in the supratentorial group,with a passing rate of 61.5%.Among the 4 cases in the supratentorial group who did not pass the TCD judgment,3 cases were patients with craniocerebral decompression after craniotomy,and 1 case was patients with open craniocerebral injury.In SLSEP judgment results,40 cases were passed in the sup group,with a pass-through rate of 74.1%,and 25 cases were passed in the sup group,with a pass-through rate of 96.2%.In the EEG judgment results,52 cases passed in the supratentorial group,with an approval rate of 96.3%,and 22 cases passed in the subtentorial group,withan approval rate of 84.6%.All patients met the criteria for brain death with at least two assistive techniques.The TCD pass-rate of the supratentorial group was significantly higher than that of the subtentorial group(=9.67,P<0.05),while that of the supratentorial SLSEP was significantly lower than that of the subtentorial group(=4.26,P<0.05).However,there was no significant difference in EEG passing rate between the supratentorial group and the subtentorial group(x2=3.452,P=0.084).(2)Of the two groups,23 patients in the disc-electrode group showed electrical silencet.Two patients with brain stem hemorrhage did not meet the criteria.24 patients in the needle-electrode group showed electrical silencet.One patients with brain stem hemorrhage did not meet the criteria.The placement time of the needle-electrode group was significantly lower than that of the disc-electrode group[(10.16±1.43)min<(20.92±1.96)min,t=22.180,P<0.001].The resistance of the needleelectrode group was also significantly lower than that of the discelectrode group[(2.30±0.11)min <(3.80±0.21)min,t=31.637,P<0.001].Conclusion:(1)When using TCD to determine brain death,patients with primary supratentorial lesions had a higher pass-through rate than those with subtentorial lesions.When SLSEP was used to determine brain death,the rate of subtentorial patients was higher than that of supratentorialpatients.Patients with decompression of bone flap have a poor pass rate of brain death determined by TCD.When EEG was used to determine brain death,the passing rate of patients with brainstem hemorrhage was lower.Selecting appropriate auxiliary examination according to the location of the primary lesion of severe craniocerebral injury is of great significance for the rapid evaluation of brain death.(2)Through the compare between the setting time and resistance of the disk electrode and the needle electrode,it was found that the needle electrode was more time-saving and labor-saving than the disk electrode.At the same time,the resistance of the needle electrode is less,which can also obtain better EEG waveform.Meanwhile,it can greatly shorten the time of using EEG to determine brain death. |
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