Dergi Ara >>
Yıl:2003; Cilt: 4; Sayı: 1>> Özet
Türkiye Klinikleri Psikiyatri Dergisi; 2003;4(1):68-71
Beyin ölümü ve kafa travmaları
H Durak, GÇ Kaya
Dokuz Eylül Üniversitesi Tıp Fakültesi Nükleer Tıp AD, İzmir
Yoğun bakım ünitelerindeki en son teknik ilerlemeler ve bu alandaki bilimsel gelişmelerle, geçen yüzyılda yaşaması mümkün olmayacak birçok hasta, yaşamsal destek sağlanarak, hayatta tutulabilmektedir. Transplantasyon cerrahisindeki son gelişmeler ve bu alanda immünsüpresif tedavinin kullanımı da eklenince, transplantasyon için organ alınması ve komadaki hastanın yaşamsal desteğini sürdürüp sürdürmemek konusunda karar verilmesi gereği, ölüm tanımının gözden geçirilmesi ve beyin ölümü tanısı konusunda kriterler ortaya konmasını zorunlu hale getirmiştir. Az sayıda organ donörü bulunabilmesinin ana nedenleri arasında beyin ölümü tanısının gecikmesi, önemli bir yer tutmaktadır. Avrupa ülkelerinin çoğu beyin ölümü tanısı için tavsiye edilen kriterleri yayınlanmıştır. Ölüm tanısından farklı olarak, beyin fonksiyonlarının tümüyle ve geri dönmez şekilde kaybının tanısı ve kriterleri, ülkeler arasında farklılıklar göstermektedir. Klinik inceleme ve bulgular aynı olduğu halde, destekleyici teknik testlere ait yönergeler farklıdır. Bazıları hiçbir test kullanmazken, bazı ülkelerde birden fazla test yapılır. Tanı için temel olarak, derin koma, tüm beyin sapı reflekslerinin kaybı ve apne mevcut olmalıdır. Santral Sinir Sistemini deprese eden ilaçlar kullanıldığında, ilaç serumdan klirense uğrayana kadar, klinik ve EEG güvenilir olmaz. Bu durumda ve diğer gerekli durumlarda, intrakranial dolaşımın durduğunu gösteren incelemeler, tanının gecikmesini önleyebilir.

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