Know the brain death with the scientific attitude

Know the brain death with the scientific attitude
Staff reporter Yang QiuLan Have a long history about the discussions of brain death concept and diagnostic standard, has already more than 80 countries have issued and implemented the brain death law or brain death and judged the standard in the world. Through the efforts for many years, recently, the standard dies to draft " the brain death will have judged the standard " that the group made by the brain of Ministry of Public Health and " technical specification " will be released soon. Do brain death standard and traditional standard death of heart and lungs have anything different? Who judges the brain death? Does the doctor judge whether the brain death means giving up treating and curing? These questions, the reporter has interviewed " standard " and " technical specification " to draft and make to expert, expert of Capital University of Medical Sciences Beijing Xuanwu Hospital department of nerve internal medicine Professor Ling Feng and Great Britain Professor of Great Britain of constellation. The irreversible death of the brain is that the people's death standard is that people use to weigh and judge the yardstick of the death. The traditional death standard is to regard stop of the heart and lungs function as the sign, namely breathe the heartbeat to stop. This standard is very ocular, it is not merely the judgement indexes of the hospital, medical college, also the life terminal that the public approves. But with the development of medical science, the support means of the life is being strengthened constantly, the problem has taken place in too single a traditional heart and lungs death standard. Often present such a phenomenon on clinic: In some the fatal critical patient's rescue course that damages brain for various reasons, though patient's brain has already totally stopped life activity irreversibly, under the organ support means that modern medical science is strong, the function of the patient's important organ of these of kidney of heart and lungs liver can be extended or substituted partly, that the intersection of patient and heart these also beat ' The strong heart medicine is supported) ,Seem, breathe even ' Actually artificial respiration machine is in work) ,Have rosy cheeks, the trick is warm (blood pressure keeps normal) ,Even still can see the intersection of hair and growth of beard ' Artificial nutrition is supported) When. But in fact, all clinical practice proves, even stronger medical technical support, because of the death of life centre cells, the death of the other parts of patient's organism is inevitable too and appear in succession within short time. At this moment, all efforts of doctor and nurse and patient relative, are instead of rescuing a brain death patient, are not just lengthening the death course of the brain death patient as to say. In other words, we can have artificial hearts, extracorporal circulatory system machine, pace maker, breathing machine and artificial liver and artificial kidney, can even make transplanting, liver renal transplantation of heart and lungs. However, at present at least, there is no brain in actual meaning to transplant to have artificial brain. No matter as organism or social people, the irreversible death of the brain marks the irreversible death of the human body. So, as to this part of patients, regard the brain death standard as the death standard and have very important meanings. In 1959, France reported pathological change in 23 primary craniums or breathed the heartbeat and was considered to be the patient who go into a coma deeply after stopping recovering, clinical manifestation, in order that to any stimulating reactionlessly, without spontaneous activity, have not breathed (necessary machinery and kept in touch with and maintained and stepped up medicines to maintain independently) ,The electroencephalogram presents the flat straight line, the final heartbeat stops. In 1966, at the international conference of Marseilles of France, this kind of case was named as brain death. In 1968, the medical college of Harvard University proposed the brain death was judged(or diagnosed) Standard. Hereafter, a lot of countries and regions in the world had their own brain death that judged the standard in succession. On clinic, judging, besides breathing the heartbeat to stop, one more brain dies to death. The expert points out, the brain death is a fact existing objectively, it is accepted that this fact marks the progress of medical science, have reflected the progress that the mankind realizes to the life meaning. As the social individual, have the right to safeguard and survive, die there is right dignitying too. The respect to the dead of the persons who give birth to is not merely a funeral, and the respect to the dead's remain. Just think, already the dead of the brain death have been still by the breathing machine keeping breathing and heartbeat, except that any rescues the meaning, the maintenance of the dead's remain, dignity of remains of the deceased is also extremely unfavorable. In addition, relative's unnecessary economic consumption, spirit loss and the waste of medical resources, bring serious family and social concern. And the reason that the brain death should go into a coma clearly gets rid of all reversible stupor to it is reported, " standard " is clear, pay attention to the state in irreversible venereal disease that the brain death refers to the whole brain function including brain stem and loses. Say popularly, mean the brain cell as life centre and consciousness core all die, its characteristic is shown as and gone into a coma deeply, the brain stem is launched and all disappeared, breathe and stop (need the breathing machine to keep breathing) independently . The brain death of our country judges the standard mainly includes: 1. Precondition: Go into a coma clear reason ' Including primary and continues taking place brain injury for brain injury) ,Reason for getting rid of all reversible stupor. 2.Judge clinically: Go into a coma deeply, the brain stem is reflected and all disappeared (including the pupil light reflex, cornea reflecting, head eyes reflecting, eyes reflecting, cough reflex of vestibule) ,Breathe and stop (maintain by the breathing machine, it verifies that has not breathed independently to breathe and bring out the test independently . The above 3 items all possess. 3.Confirm testing: The electroencephalogram presents electricity quietly to stop, is have no blood flow of brain to pour into the phenomenon by Doppler's supersound of cranium, the body sense brings out above P14 wave form of the electric potential and disappears. In the above 3 items to have at least 2 items are positive. 4.The viewing time of brain death: After judging for the first time, have no change to reexamine to observe for 12 hours, can judge as the brain death. The expert introduces, have clinically, 95% present circulatory failure at first at death to close to the death crowd and the heart stops fighting, then breathe and stop the death, namely heart and lungs death. Probably only 5% of the death case departments take place or continue and take place brain pathological change depletedly to the centre and breathing and stopping, need to do the brain death to judge under maintaining the function state of heart and lungs manually. What disease can cause the brain death? The brain death is divided into primary brain death and continues the taking place brain death. The primary brain death is caused by primary cerebral disease or damage, then the sending brain death results from or is damaged and causes the oxygen deficiency of brain or supersession obstacle by primary diseases of the organ outside the brain such as the heart, lung,etc.ing. The basic reason of the brain death is: Serious damage, bleeds, the inflammation, tumour, brain edema, brain oppression, brain hernia or continuing taking place in the function obstacle of heart and lungs that the brain organizes. The expert especially points out, the present brain death standard is an adult's, are not suitable for babies. This is because the baby is unconscious, only have a brain in a biological meaning, and the baby's biological behavior is very different from adult. So, judge to the baby's brain death that will set up the rule separately. The brain death concept can't totally replace the traditional heart and lungs death concept expert to point out yet, though there is brain death that judges the standard, the brain death concept can't totally replace the traditional heart and lungs death concept yet. For two reasons: First, as stated above, all the disease dies The brain death appears and need to do the brain death to judge first in the example. Second, the brain death standard? It cut deer Xie Rui the �� s to last Cha medicine to last scandium �� angstroms of �Ȧ� s miscellaneous Xie of benzyl 1 deer to last alliance �� torrs of Yao skin Suo ���� Su Shun Huo of ���� 1 Gua t already ���� Pu Huan? What similarities and differences place do brain death and heart and lungs death have? The expert points out, brain death standard and physiologic meaning of pathology of the heart and lungs death standard are essentially the same, but emphasize different course under the same pathologic state in statement. In other words, the standard death of both standard death of heart and lungs and brain is the death. Distinguish, lie in heartbeat breathe, stop first only and then the intersection of brain and death, or the intersection of brain and death and then heartbeat breathe and stop first, the course of two is different and the result is the same. Generally speaking, weigh according to the death standard of heart and lungs, breathe to stop taking between several minutes and more than ten minutes since the heartbeat to the brain death. But after the brain death, support the application of technology because of the advanced heart and lungs function, several days, one week is even longer that the heartbeat can often last, but die because of being unable to maintain the heartbeat without exception finally. On clinic, even if the doctor judges patients as the brain death, perhaps some relatives still can't accept, still hope the doctor rescues. The expert points out, at present, a large number of medical materials prove, the patient in brain death state, even use the medical technical support of the supreme level, die in a short time without exception finally, it is the impossible task that is finished of one to come back to life. The intersection of brain and death and vegetable, it goes into a coma to be no that the same thing people see " vegetables " often deeply The report woken up, " vegetable " Is it different to have anything with the brain death? Also someone will worry, if the patient just goes into a coma deeply, be judged the brain death by mistake? The expert introduces, " vegetable " that commonly called as In the current definition of the medical circle is " The plant state of the continuation " ,The intersection of cranium and the intersection of brain and traumatism or other damage often, the intersection of brain and ischemic the intersection of oxygen deficiency and disease, neuronal the intersection of regression and the intersection of and change,etc.s, such as suffocate, drowned, apoplexy,etc. cause long-term the intersection of consciousness and obstacle. Shown as, the patient is reactionless to the environmental fine long hair, totally lose the ability of cognition of the one one's own and around; Although the patient can swallow the food, open eyes, fall asleep and awaken, there is no difference of the daytime of night, can't move limbs at will, totally lose self-care ability of life; Can keep the basic function that body survives, such as metabolism, grow. Therefore, brain death and vegetable are totally different concepts. The essential difference lies in: The brain death is a death state totally lost because of the whole brain function; And the vegetable is the long-term stupor state caused by serious damage of the brain function, it is a kind of serious deformity. The significant difference lies in whether the patient breathes independently clinic. The patient of the brain death has not breathed independently, totally rely on the artificial respiration machine; And the vegetable breathes independently. The brain death does not equate with going into a coma deeply either. Expert introduce, it goes into a coma to be serious the intersection of consciousness and obstacle deeply, show as to stimulate reactionless any, whole body is of flaccid muscles, the eyeball is fixed, the pupil breaks up greatly, various areflexia, the obvious change takes place in the physical sign of the life, such as breathe abnormality, disorder of rhythm of the heart, blood pressure fluctuation,etc.. But in going into a coma deeply state patient there will be possibility of waking up also, brain function there will be possibility of resuming even. The brain death is the lose of the whole brain with irreversible function, besides going into a coma deeply, should also include the areflexia of brain stem and not breathe independently. (including P14) in confirm in brain laboratory of death check, centre short nerve the intersection of body and sense bring out electric potential, show as after the P14 incubation period Wave form disappear and electroencephalogram present flat straight line, disappear through ultrasonic blood flow, Doppler of cranium. So, the brain death is different from going into a coma deeply. The bang if the serious neural function damages patient's phoenix TV station host Liu HaiRuo and enforces the drug law the hero Luo Jin is brave it is the successful case which Xuanwu Hospital of Capital University of Medical Sciences treats and cures. Someone mistakes them for a brain death patient. But the expert points out, they are all critical neural functions damage a patient, but not brain death. Liu HaiRuo causes serious occuring frequently wounded because of the traffic accident, including cranium brain traumatism, rotate and come back home in a wounded the last month. The patient was shown as the intermediate stupor at that time, light reflex of pupil and cornea reflected the existence in the brain stem was reflected, breathe and store in independently, the body sense brings out dual sides N20 of electric potential and exists in short incubation period of nerve in the centre, the electroencephalogram presents the slow wave ' �� wave and �� wave) Increase and display and irritate, store to pain in and react, the blood flow is basically normal from Doppler's ultrasonic cranium of cranium. Though patients are still in a coma, it is fair to assess the result the brain function, the sober possibility recovering still exists. Under the medical personnel's joint efforts of Xuanwu Hospital, especially under the care which insults the medical personnel of department of neurosurgery of the sharp point headed by professor, future trouble person is sober in 3 months, and is recovering constantly. The brain death should be judged that there is brain death that judge the standard by the doctor with professional qualification, do not mean each doctor can judge the patient. The expert says, the brain of Ministry of Public Health dies to judge that drafts the group to propose in standard, " standard " and " technical specification ", during clinical practice, Ministry of Public Health should make relevant management. The expert reveals, judging it is a serious and rigorous science that works of brain death, pass the strict procedure. Relevant management may stipulate, clinical when fooled a patient and presented the obvious brain death sign, in charge of a doctor to judge preliminarily and clinically, judge to the brain death the centre puts forward the written application after soliciting a patient family members to agree to according to the condition, apply for the brain death to judge the expert panel judges the brain death. All judge a doctor must hold the brain death to judge medical practitioner's qualification authorizes the book, the doctor participating in judging can not be engaged in organ transplant and relevant discipline, and there is not obvious relation with the possible organ recipient. For respect and scientific and exact attitude to patient's life, in order to get rid of all possible interference and uncertainty, judge the procedure must go on repeatedly 12 hours later, the doctor proposes judging independently separately according to the procedure, it can be judged finally that the result is unanimous. The expert reveals, in order to make the brain death judge working science goes on in order, advance the brain death to judge the next step of the work is to train pilot medical organization and personnel and authorize. The main personnel trained should work in the department of nerve internal medicine, department of neurosurgery, department of anesthesia, emergency medical dept. and medical department of serious disease for more than 10 years, doctor and relevant technical staff with advanced professional title for technical personnel. Only train qualified medical organization and personnel to have brain death to judge the qualification. The expert points out, at present, our country has not enforced the regulation that the brain death judged. If relative put forward requirement, where one stays hospital can to have brain death judge medical organization and person of the qualification file an application. If judge that will follow relative's will and continue treating and curing or stopping rescuing for the brain death.

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