Su Ying-ying, Yang Qing-lin, Pang Ying, Lü Xiang-ping
Department of Neurology, Xuanwu Hospital, Capital University of Medical Sciences, Beijing 100053, China.
Zhonghua Nei Ke Za Zhi. 2005 Apr;44(4):248-50.
To investigate the accurate and objective methods of evaluating coma after cardiopulmonary resuscitation.
Cases that were still in coma 24 hours after cardiopulmonary resuscitation were continuously observed and evaluated between April 2002 and November 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).
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 grade I. 11 of the 35 cases survived and their state of consciousness changed from deep coma to coma vigil, EEG evaluated was grade I in 5 cases. BAEP and SLSEP were grade I in the 3 cases evaluated and GOS is grade II. 2 cases (18.2%) regain consciousness at the time of 35 and 90 days after cardiopulmonary resuscitation and their GOS was grade IV and grade III respectively.
Combined and continuous observation of clinical manifestations and laboratory parameters can accurately and objectively evaluate coma after cardiopulmonary resuscitation.
探讨心肺复苏后昏迷评估的准确、客观方法。
对2002年4月至2004年11月心肺复苏后24小时仍处于昏迷状态的病例进行持续观察和评估。评估方法包括各种临床检查，如意识状态、格拉斯哥昏迷评分（GCS）、脑干反射、脊髓反射等。其他评估方法包括实验室检查，如脑电图（EEG）、脑听觉诱发电位（BAEP）、短潜伏期体感诱发电位（SLSEP）和经颅多普勒（TCD）。
35例患者中24例（68.6%）处于深昏迷状态，GCS评分为3分。EEG评估除4例外在所有病例中均不少于Ⅳ级；BAEP评估除3例外在所有病例中均为Ⅲ级；SLSEP评估除1例外在所有病例中均为Ⅲ级。24例在1个月内死亡，其中11例（45.8%）被评估为脑死亡，格拉斯哥预后评分（GOS）为Ⅰ级。35例中有11例存活，其意识状态从深昏迷转变为昏迷警觉，EEG评估5例为Ⅰ级。评估的3例中BAEP和SLSEP为Ⅰ级，GOS为Ⅱ级。2例（18.2%）在心肺复苏后35天和90天时恢复意识，其GOS分别为Ⅳ级和Ⅲ级。
临床表现和实验室参数的联合及持续观察可准确、客观地评估心肺复苏后的昏迷情况。
