Dergi Ara >>
Yıl:2006; Cilt: 19; Sayı: 3>> Özet
TAM METİN
Düşünen Adam: Psikiyatri ve Nörolojik Bilimler Dergisi; 2006;19(3):137-142
Hastanemizde Beyin Ölümü Deklarasyonu
S Büyükkınacı, U Erdoğan, H Toplamaoğlu, B Uçar
Bakırköy Ruh ve Sinir Hastalıkları Hastanesi
Beyin ölümü, tüm serebral ve beyin sapı fonksiyonlarının tam ve geri dönüşsüz kaybıdır. Beyin ölümü tıbbi ölüm hali olarak, kabul edilir. Türkiye'de ve dünyada beyin ölümü adli ve medikal çevrelerde yüksek oranda benimsenmektedir. Son yıllarda organ transplantasyonlarındaki donör arayışları üzerine yapılan çalışmalar bu konuya olan ilgiyi giderek arttırmaktadır.
Amaç: Nöroşirurji ve nöroloji uygulamalarında beyin ölümüne yaklaşım ve konunun önemim belirtmek amaçlı bir çalışma yaptık.
Yöntem: Hastanemizden rasgele seçilmiş 15 nöroşirurji ve 15 nöroloji doktoruna beyin ölümü ile ilgili 4 sayfalık bir anket uygu­landı. Anketler "evet" - "hayır" listesi yapılarak değerlendirildi. Ek bir yorum yapılmış ise o da ankete ilave edildi.
Bulgular: Teşhis için kullanılan kriterlerin cevap verenler arasında anlamlı şekilde değiştiği sonucufıa varıldı. Buna göre çoğu; di­late pupil varlığını (% 93), pupiller refleks yokluğunu <% 70), korneal refleks yokluğunu (% 83), ventilatörden ayrıldığında solunum eforunun olmayışını (% 77), kafa çevirme ile göz hareketlerinin olmayışını (% 70) tercih ediyordu. Daha az bir kesimin ise: Derin Tendon Refleksi olmayışım (% 10), öfcürük refleksinin olmayışını (% 7), Öğürme refleksinin olmayışım (% 17), 32.2°C üstünde vü­cut ısısı oluşunu (% 13), ve w kan barbitiirat düzeyinin "0" oluşunu (% 7) tercih ediyordu. % 13 oranında EEG istenmediği ve % 50'sinin tek bir EEG. % 37si de 24 saat arayla 2 EEG'yi yeterli bulduğu tespit edildi. Ankete cevap verenlerin % 17'si anketten önceki 5 yıl içinde beyin ölümü beyanını 5'den fazla yapmıştı.
Sonuç: Beyin ölümü deklarasyonu konusunda hasstanemizdeki doktorların bakış açtlarındaki çeşitlilik, işlemekte olan oturmuş bir sistem olmadığı yapılan anketlerle ortaya konulmuştur. Bu konuda işleyen bir sistemin kurulması ve ortak kriterlerin kullanılması
gerekmektedir.
Brain Death Declaration In Our Hospital
Brain death is the irreversible loss of ail cerebral and brain stem functions. Brain death is accepted as the medical state of death. Brain death is commonly accepted by the judicial and medical environment in Turkey and worldwide. In the last [year]s, the studies on finding organ transplantation donors increase the interest in this subject.
Objective: We conducted a study to explain the approach to brain death in neurosurgical and newological applications, ami show the importance of the subject.
Methods: A 4 page poll about brain death is given to 15 newosurgeons and 15 neurologists randomly chosen in our hospital. The polls are evaluated by making "yes" - "no" lists. Additional interpretations are also added.
Results: The criteria used for diagwsis changed extensively between the doctors who answered the poll. Most of them chose dila­ted pupils existence (93 %), pupillar reflex nonexistence (70 %), corneal reflex nonexistence (83 %), nonexistence of respiration ef­fort when separated from the ventilator (77 %), nonexistence of eye movement with head turns (70%). A smaller amount chose no­nexistence of cough reflex (7 %), no Deep Tendon Reflex (10 %), nonexistence of retching reflex (17 %), body temperature over 32.2°C (13 %), or "0" blood barbimrate level (7 %). 13 % did not require EEG and 50 % said one EEG is enough and 37 % said 2 EEGs in 24 lioiir intervals is enough.
Conclusion: These questionnaires show that there is a large variation between the climcians and there are no well-establislied cri­teria about brain death declaration. We need common criterion for brain death diagnosis and also we need a well working system for declaration.

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