- 期刊
腦死判定的演變與呼吸暫停測試之新發展
Evolution of brain death determination and new development in the apnea test
摘要
腦死又稱腦死亡（brain death, BD），是大多數國家與大多數情況下作為「死亡」判定的準則之一，通常指包括腦幹在內的全腦部功能喪失的一種不可逆狀態。一個人若腦部缺氧2－5分鐘以上，腦部細胞便開始受損，可能就會造成腦死現象。此類病人須完全仰賴呼吸器，且一旦除去便會無法自主呼吸，血壓立刻下降，心跳隨之停止。而呼吸暫停測試（apnea test, AT）就是判定腦功能缺失的其中一項評估標準，但這項舉動通常除了會造成病人發生嚴重低血氧症與血液動力學不穩定之外；無形中也導致臨床醫療人員（例如：醫師、呼吸治療師、護理師、社工師及協調師等）莫大心理壓力。因此有專家學者便提出，可運用別於以往須完全卸除呼吸器方式進行（例如：運用呼吸器持續氣道正壓系統（continuous positive airway pressure system, CPAP）或T型接管（T-Piece）連接可調節式PEEP閥（positive end-expiratory pressure -valve, PEEP-valve）等方式，故本篇將探討腦死判定的演變及AT新發展的選擇。
並列摘要
Brain death is one of the criteria used in most countries and in most cases and circumstances to determine "death". It refers to an irreversible condition of complete loss of brain function, including the brainstem. If a person's brain is deprived of oxygen for more than 2-5 minutes, can cause damage to brain cells, leading to brain death. Patients in this condition rely entirely on a ventilator and, if removed, are unable to breathe independently, causing an immediate drop in blood pressure and cessation of heartbeat. The apnea test (AT) is one of the evaluation criteria used to determine brain function loss. However, this procedure often causes severe hypoxemia and hemodynamic instability in patients, and it also puts significant emotional stress on clinical medical staff, including physicians, respiratory therapists, nurses, social workers, and coordinators. Therefore, some experts and scholars have proposed alternative methods for conducting the test, such as using a continuous positive airway pressure system (CPAP) or a T-piece with positive end-expiratory pressure-valve (PEEP-valve) instead of the traditional method of completely removing the ventilator. This article will explore the evolution of brain death diagnosis and new developments in the AT, including the challenges and concerns of medical personnel and the well-being of patients.