脑外伤长期昏迷病人促醒治疗

Consciousness-regaining therapy for patients with prolonged coma from brain injury

目的 探讨脑外伤长期昏迷病人促醒途径。方法 自1986年5月～1999年12月,对142例严重脑外伤病人集中后续治疗,并进行头颅CT、MRI、脑干诱发电位及脑电功率谱随访研究。结果 102例(71.83％)在经过平均92天的昏迷期(30天～36个月)后恢复意识,其中25例(24.5％)恢复工作或学习,生活自理52例(51％)及25例仍需他人照料。结论 认为脑外伤长期昏迷病人经过积极治疗后,其中部分病人可望恢复意识,头颅CT、MRI、脑干诱发电位及脑电功率谱能从不同角度对脑外伤长期昏迷者预后估价提供明确客观指标。

Objective To explore the process of consciousness-regaining in the patients with prolonged coma for more than 30 days. Methods 142 patients with prolonged coma from severe head injury were admitted for concentric rehabilitation from May 1986 to December 1999 in the hospital. Their results of CT, MRI, BAEP and EEG power spectrum at the follow-up were analyzed. Results 102 cases (71.8 %) regained consciousness after the coma stage of averaged 92 days (ranging from 30 days to 36 month). Among them, 25 cases (24.5 %) resumed their previous work or study, 52 cases (51 %) led practically normal lives and 25 cases still needed care from others. Conclusion Posttraumatic coma persisting for more than a month should not be consi dered irreversible because some patients can regain consciousness in spite of severe brain damage. Head CT, MRI, BAEP, and EEG power spectrum are excellent long-term global outcome predictors in severe head injury patients with prolonged posttraumatic coma.