Cheliout-Héraut F, Durand M C, Clair B, Gajdos P, Raphaël J C
Service central d'explorations fonctionnelles, hôpital Raymond-Poincaré, Garches, France.
Neurophysiol Clin. 1992 Sep;22(4):269-80. doi: 10.1016/s0987-7053(05)80259-x.
Ten cases of postanoxic coma have been studied. A clinical neurological examination with study of brainstem reflexes and the EEG recording were made on the first day (J1), the third day (J3) and the tenth day (J10) after the start of the coma. A recording of the visual evoked potentials, the brainstem evoked potentials and the somatosensory potentials combined was made at the same time. A clinical examination is carried out one month after the coma when the patient survives. According to the initial clinical examination, we distinguished 3 groups of subjects. The results show that in group III the visual evoked potentials such as EEG have a slightly significant prognostic value; frequently the near outcome lead to death whereas EEG activity persists and the visual evoked potentials disappear later. On the other hand, the association of brainstem evoked potentials and somatosensory potentials clearly has a higher prognostic value in this group. The disappearance of the shortest brainstem responses and the cortical somatosensory responses is clearly an unfavourable prognosis. This disappearance associated with the end EEG activity is the absolute proof of brain death. On the other hand, the persistence of these responses is of a better prognosis at least on the survival level, but their degradation during evolution is unfavourable.
对10例缺氧后昏迷患者进行了研究。在昏迷开始后的第1天（J1）、第3天（J3）和第10天（J10），进行了临床神经学检查，包括对脑干反射的研究以及脑电图记录。同时记录了视觉诱发电位、脑干诱发电位和体感诱发电位的组合。当患者存活时，在昏迷一个月后进行临床检查。根据初始临床检查，我们区分出3组受试者。结果显示，在第三组中，视觉诱发电位与脑电图一样具有一定的预后价值；通常近期结局是死亡，而脑电图活动持续存在，视觉诱发电位随后消失。另一方面，在该组中，脑干诱发电位和体感诱发电位的联合显然具有更高的预后价值。最短的脑干反应和皮层体感反应的消失显然预后不良。这种消失与脑电图活动的终止相关是脑死亡的绝对证据。另一方面，这些反应的持续至少在存活水平上预后较好，但在病程中其退化则预后不良。
