Meyer Matthew J, Megyesi Joseph, Meythaler Jay, Murie-Fernandez Manuel, Aubut Jo-Anne, Foley Norine, Salter Katherine, Bayley Mark, Marshall Shawn, Teasell Robert
Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada.
Brain Inj. 2010;24(5):722-9. doi: 10.3109/02699051003692134.
To review the literature regarding techniques used to promote arousal from coma following an acquired brain injury.
A literature search of multiple databases (CINAHL, EMBASE, MEDLINE and PsycINFO) and hand searched articles covering the years 1980-2008 was performed. Peer reviewed articles were assessed for methodological quality using the PEDro scoring system for randomized controlled trials and the Downs and Black tool for RCTs and non-randomized trials. Levels of evidence were assigned and recommendations were made.
Research into coma arousal has generally focused on the stimulation of neural pathways responsible for arousal. These pathways have been targeted using pharmacological and non-pharmacological techniques. This review reports the evidence surrounding agents targeting dopamine pathways (amantadine, bromocriptine and levodopa), sensory stimulation, music therapy and median nerve electrical stimulation. Each of these interventions has shown some degree of benefit in improving consciousness, but further research is necessary.
Despite numerous studies, strong evidence was only found for one intervention (Amantadine use in children) and this was based on a single study. However, each of the interventions showed promise in some aspect of arousal and warrant further study. More methodologically rigorous study is needed before any definitive conclusions can be drawn.
回顾关于后天性脑损伤后促进昏迷苏醒所使用技术的文献。
对多个数据库（CINAHL、EMBASE、MEDLINE和PsycINFO）进行了文献检索，并人工检索了1980 - 2008年的文章。使用针对随机对照试验的PEDro评分系统以及针对随机对照试验和非随机试验的唐斯和布莱克工具，对同行评审的文章进行方法学质量评估。确定了证据水平并提出了建议。
对昏迷苏醒的研究通常集中在对负责苏醒的神经通路的刺激上。这些通路已通过药理学和非药理学技术作为靶点。本综述报告了围绕针对多巴胺通路的药物（金刚烷胺、溴隐亭和左旋多巴）、感觉刺激、音乐疗法和正中神经电刺激的证据。这些干预措施在改善意识方面均显示出一定程度的益处，但仍需进一步研究。
尽管有大量研究，但仅在一项干预措施（儿童使用金刚烷胺）中发现了有力证据，且这是基于一项单一研究。然而，每种干预措施在苏醒的某些方面都显示出了前景，值得进一步研究。在得出任何明确结论之前，需要进行更具方法学严谨性的研究。
