心肺复苏后昏迷的评估研究

Evaluation of coma after cardiopulmonary resuscitation

目的探讨准确、客观评估与判定心肺复苏后昏迷的方法。方法对35例心肺复苏后24h仍处于昏迷状态的患者进行前瞻性脑功能状态的动态评估,评估项目包括临床指标、神经电生理指标和脑血流指标。结果35例中深昏迷的24例患者,格拉斯哥昏迷评分均为3分,脑电图除4例外均≥Ⅳ级,脑干听觉诱发电位(BAEP)除3例外均为Ⅲ级,短潜伏期体感诱发电位(SLSEP)除1例外均为Ⅲ级,全部患者复苏后1个月内死亡。24例中11例(45.8%)判定为脑死亡,格拉斯哥预后分级(GOS)评为Ⅰ级;其余11例存活患者从昏迷到睁眼昏迷,5例脑电图为Ⅰ级、3例BAEP和SLSEP为Ⅰ级,GOS均为Ⅱ级,其中2例(18.2%)分别在第35、90天清醒,GOS评为Ⅲ级和Ⅳ级。结论临床与实验室指标相结合综合评定心肺复苏后昏迷更加客观、准确、可靠,并对临床医疗决策和提高脑复苏成功率具有重要的指导意义。

Objective To investigate the accurate and objective methods of evaluating coma after cardiopulmonary resuscitation.Methods Cases that were still in coma 24 hours after cardiopulmonary resuscitation were continuously observed and evaluated between April 2002 and Novemember 2004.The methods of evaluation included various clinical examinations, for instance conscious state,Glasgow coma score (GCS),brain stem inflection, spinal reflexes and so on. Other methods of evaluation included laboratory examinations, such as electroencephalography (EEG),brain auditory evoked potential (BAEP),short latent somatosensory evoked potential (SLSEP) and transcranial doppler (TCD) .Results 24 of a series of 35 cases(68.6%) were in deep coma .The GCS is score 3 . EEG evaluated was not less than grade Ⅳ in all except 4 ;BAEP evaluated was grade Ⅲ in all except 3; SLSEP evaluated was grade Ⅲ in all except 1 .24 cases died within 1 month and 11 of them(45.8%)were evaluated as having brain death and Glasgow outcome score (GOS) was gradeⅠ. 11 of the 35 cases survived and their state of consciousness changed from deep coma to coma vigil, EEG evaluated was grade Ⅰin 5 cases. BAEP and SLSEP were gradeⅠ in the 3 cases evaluated and GOS is gradeⅡ.2 cases(18.2%)regain consciousness at the time of 35 and 90 days after cardiopulmonary resuscitation and their GOS was grade Ⅳand grade Ⅲ respectively.Conclusion Combined and continuous observation of clinical manifestions and laboratory parameters can accurately and objectively evaluate coma after cardiopulmonary resuscitation.