To confirm the usefulness of N18 and other SEP components of medullary origin for the diagnosis of brain death

确认 N18 和其他髓质来源的 SEP 成分在诊断脑死亡中的有用性

基本信息

批准号：
09670669
负责人：
SONOO Masahiro
金额：
$ 1.98万
依托单位：
Teikyo University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
1997
资助国家：
日本
起止时间：
1997 至 1999
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-09670669/
关键词：
somatosensory evoked potentials (SEPs)median nerve brain death criteria to diagnose brain death N18 auditory brainstem responses (ABRs)brainstem function cuneate nucleus in medulla oblongata 脳幹機能 P13 14電位 P9電位

项目摘要

1. We collected around 140 recordings of SEP and ABR together with clinical signs from around 100 brain-dead or comatous patients during the 3 years we accepted the grants. As a result, N18 in median SEPs was lost in all the brain-dead recordings whereas it was preserved in nearly 90% of comatous but not brain-dead recordings. Namely, N18 had perfect specificity and very high sensitivity (higher than ABR which was preserved for about 80% of comatous recordings) for detecting the remaining brainstem function.2. We managed to follow the course progressing from coma to brain-death in 8 patients having brain herniation. Signs reflecting midbrain function such as light reflex and oculocephalic reflex were first lost, those reflecting pontine function such as corneal reflex and wave III in ABR followed. Lastly, loss of cough reflex and pharyngeal reflex, cease of spontaneous respiration, sudden fall of blood pressure and loss of N18 occurred within a short time and brain-death was judged to be established. The fact that N18 disappeared concomitantly with these signs reflecting medullary functions further supported our opinion that N18 is generated by the cuneate nucleus located in the medulla oblongata.3. There has been no neurophysiological or other method which can objectively evaluate the function of medulla oblongata which plays the most important role for maintaining the vital functions. ABR can evaluate only pontine and midbrain functions. The present investigation established N18 as the first objective indicator for the medullary function. Wide clinical application of N18 must increase the reliablity of the diagnose is of brain death.4. Other related researches performed include: the origin of the P13-like potential which remains after brain death (by Sonoo), the origin of P9 (by Mochizuki and Sonoo) and the best method to determine the stimulus intensity in median SEPs (by Fukuda and Sonoo).

1。在三年内，我们收集了大约140张SEP和ABR记录，以及来自约100名脑死亡或昏迷患者的临床体征。结果，在所有脑死亡记录中，中位SEP中的N18丢失了，而将近90％的昏迷但没有脑死亡的记录保存下来。也就是说，N18具有完美的特异性和非常高的灵敏度（高于ABR，可用于检测剩余的脑干功能的80％的com录音）2。在8例患有脑部催眠的患者中，我们设法遵循了从昏迷到脑死亡的课程。反映中脑功能（例如光反射和眼头反射）的符号首先丢失，随后反映了蓬托函数（例如角膜反射和波浪III）的符号。最后，咳嗽反射和咽反射的丧失，自发呼吸停止，血压突然下降以及N18的损失发生在短时间内，并判断脑死亡是确定的。 N18与这些反映髓质功能的这些迹象同时消失的事实进一步支持了我们认为N18是由位于髓质圆形的cuneate核产生的。3。没有神经生理学或其他方法可以客观地评估髓质的髓质功能，这在维持重要功能方面起着最重要的作用。 ABR只能评估蓬托和中脑功能。本研究确立了N18作为髓质功能的第一个目标指标。 N18的广泛临床应用必须增加诊断的可靠性。4。进行的其他相关研究包括：类似p13的潜力的起源，该潜力在脑死亡后（由Sonoo），P9的起源（由Mochizuki和Sonoo）以及确定中位数SEP的刺激强度的最佳方法（由福生和福库达（Fukuda）和Sonoo）。