TCD characterized spectra oscillation wave and nail wave in determining brain death in patients accepted decompressive craniectomy
10.3760/cma.j.cn115354-20240509-00288
- VernacularTitle:TCD的特征频谱振荡波和钉子波在去骨瓣减压后患者脑死亡判定中的价值分析
- Author:
Yuan LIAO
1
;
Hua LIU
;
Lingling XU
;
Guixing XU
Author Information
1. 中山大学附属第一医院器官移植中心，广州 510080
- Keywords:
Decompressive craniectomy;
Brain death;
Transcranial Doppler;
Oscillatory wave;
Nail wave
- From:
Chinese Journal of Neuromedicine
2024;23(6):571-577
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the values of transcranial Doppler (TCD) characterized spectra oscillatory wave and nail wave in determining brain death in patients accepted decompressive craniectomy (DC).Methods:One hundred and eighty-nine patients with brain death caused by neurological severe diseases admitted to Department of Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University from January 1, 2021 to December 31, 2023 were enrolled: 51 patients accepted DC (skull incomplete group) and 138 patients did not accept DC (skull intact group). TCD, electroencephalogram (EEG) and evoked potential (EP) were performed in all patients from the skull incomplete group and in 47 patients from the skull intact group. Differences in clinical data and detectable rate of TCD characterized spectra between the 2 groups were compared. Consistency of TCD results with EEG and EP results between the skull incomplete group and skull intact group was analyzed at time interval from brain death by clinical judgment to TCD<48 h or time interval from brain death by clinical judgment to TCD≥48 h. Univariate and multivariate Logistic regressions were used to analyze the influencing factors for consistency of TCD results with EEG and EP results in patients from the skull incomplete group.Results:No significant difference in age, gender, time interval from brain injury to brain death by clinical judgment, time interval from brain death by clinical judgment to TCD, or systolic blood pressure during TCD was noted between the skull incomplete group and skull intact group ( P>0.05). Detectable rate of TCD characterized spectra in skull incomplete group (92.16%) was significantly higher than that in the skull intact group (73.91%, χ2=7.428, P=0.006). Consistency of TCD results with EEG and EP results in the skull incomplete group and skull intact group was both 100% at time interval from brain death by clinical judgment to TCD≥48 h. Multivariate Logistic regression analysis showed that time interval from brain death by clinical judgment to TCD≥48 h was an independent influencing factor for consistency of TCD results with EEG and EP results in the skull incomplete group ( OR=7.313, 95% CI: 1.612-15.973, P=0.004). Conclusion:Oscillatory wave and nail wave in TCD observed at time interval from brain death by clinical judgment to TCD≥48 h are the characteristic performances for brain death in patients accepted DC.
