Adukauskiene Dalia, Budryte Brigita, Karpec Diana
Department of Intensive Care, Kaunas University of Medicine, Kaunas, Lithuania.
Medicina (Kaunas). 2008;44(10):812-9.
Coma is the disorder of consciousness because of the damage to diffused bilateral cerebral hemisphere cortex or reticular activating system. Coma can be caused by neurogenic (head brain injury), metabolic (endogenic), and toxic (exogenic) factors. To determine the cause of metabolic and toxic coma, laboratory tests are performed; in case of neurogenic coma, the neurologic examination is essential, when five systems are evaluated: the level of consciousness (according to Glasgow Coma Scale or Full Outline of Unresponsiveness Scale), photoreaction of pupils and ophthalmoscopic examination, oculomotoric, motoric, and cardiopulmonary systems. For the treatment of coma, adequate oxygenation and correction of blood circulation disorders are important. The treatment of metabolic coma is guided by special schemes; antidotes often are needed in the treatment of toxic coma, and surgery helps if traumatic brain injury is present. The prognosis and outcomes of the comatose patient depend on the age and comorbid diseases of the patient, the underlying cause of coma, timely medical help and its quality, and intensive treatment and care of the patient in coma.
昏迷是由于双侧大脑半球皮质或网状激活系统弥漫性受损导致的意识障碍。昏迷可由神经源性（颅脑损伤）、代谢性（内源性）和中毒性（外源性）因素引起。为确定代谢性和中毒性昏迷的病因，需进行实验室检查；对于神经源性昏迷，神经系统检查至关重要，此时需评估五个系统：意识水平（根据格拉斯哥昏迷量表或无反应性全面量表）、瞳孔光反应及眼底检查、眼球运动、运动及心肺系统。对于昏迷的治疗，充分的氧合和纠正血液循环障碍很重要。代谢性昏迷的治疗遵循特殊方案；中毒性昏迷的治疗通常需要解毒剂，若存在创伤性脑损伤则需手术治疗。昏迷患者的预后和结局取决于患者的年龄和合并疾病、昏迷的潜在病因、及时的医疗救助及其质量，以及对昏迷患者的强化治疗和护理。
