Horn J, Zandbergen E G J, Koelman J H T M, Hijdra A
Afd. Intensive Care, Academisch Medisch Centrum/Universiteit van Amsterdam, Postbus 22.700, 1100 DE Amsterdam.
Ned Tijdschr Geneeskd. 2008 Feb 9;152(6):308-13.
Most patients with post-anoxic coma after resuscitation have a poor prognosis. Reliable prediction of poor outcomes (death or vegetative state after 1 month; death, vegetative state or severe disability after at least 6 months) at an early stage is important for both family members and treating physicians. Poor outcome can be predicted with 100% reliability in the first 3 days after resuscitation in about 80% of patients using pupillary and corneal reflexes and motor response from the neurological examination, cortical responses from somatosensory evoked potentials and EEG. The predictive value of a status epilepticus or serum levels of neuron-specific enolase is uncertain at this time. In contrast to poor outcomes, good neurological recovery cannot be predicted reliably at this time.
大多数复苏后处于缺氧后昏迷状态的患者预后较差。对不良结局(1个月后死亡或植物状态;至少6个月后死亡、植物状态或严重残疾)进行早期可靠预测,对家庭成员和治疗医生都很重要。在复苏后的头3天内,约80%的患者可通过瞳孔和角膜反射、神经学检查中的运动反应、体感诱发电位的皮质反应以及脑电图,以100%的可靠性预测不良结局。目前,癫痫持续状态或神经元特异性烯醇化酶血清水平的预测价值尚不确定。与不良结局相反,此时无法可靠地预测良好的神经功能恢复情况。