Beyin Ölümü Tanısı-Güncel Konular
Özet
Beyin ölümü klinik bir tanıdır ve tüm beyin fonksiyonlarının tam ve geri dönüşümü olmayan kaybı olarak tanımlanır. Beyin sapı da dahil olmak üzere beynin bütün olarak işlevini kaybetmesi ve bunun sonucunda yeterli bir uyaran durumunda koma, beyin sapı arefleksisi ve apne gelişmesi durumudur. Potansiyel beyin ölümü hastaları; subaraknoid kanama, serebrovasküler olay geçirmiş olan hastalar, kafa travmalı hastalar ve hipoksik ensefalopatili hastalardır. Beyin ölümü klinik değerlendirme sürecinin başlatılması için önkoşulların sağlanması ve sebep olan klinik tanının net tanımlanması gereklidir. Beyin ölümü klinik değerlendirme sürecinin ana unsurları derin koma durumunun tespiti, beyin sapı reflekslerinin kaybının gösterilmesi ve pozitif apne testidir. Beyin ölümü klinik bir tanı olup muayene genellikle tek başına yeterlidir. Muayenenin tam ve güvenilir yapılamadığı durumlarda, apne testi şartları sağlanamayan veya tamamlanamayan hastalarda, sedatif ve benzeri ilaçların etkisi öngörülemeyen ve eliminasyon yarı ömrü 5 katı süre beklenemeyecek olgularda, özellikle çocuklarda ve CPR sonrası bekleme süresinde tanı konulması amacıyla beyin kan dolaşımını gösteren yardımcı testlerin yapılması önerilmektedir
Brain death is a clinical diagnosis and is defined as the complete and irreversible loss of all brain functions. It is the loss of function of the brain as a whole, including the brain stem, resulting in coma, brain stem areflexia and apnea in the event of an adequate stimulus. Potential brain death patients include patients with subarachnoid hemorrhage, cerebrovascular accident, head trauma and hypoxic encephalopathy. Prerequisites for the initiation of the brain death clinical assessment process must be met and the causative clinical diagnosis must be clearly defined. The main elements of the brain death clinical assessment process are the detection of deep coma, demonstration of loss of brainstem reflexes and a positive apnea test. Brain death is a clinical diagnosis and examination alone is usually sufficient. In cases where the examination cannot be performed completely and reliably, in patients whose apnea test conditions cannot be met or completed, in cases where the effect of sedative and similar drugs cannot be predicted and the elimination half-life cannot be expected for 5 times the duration, ancillary tests of cerebral blood circulation are recommended for diagnostic purposes, especially in children and during the waiting period after CPR.
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