Meneses Elienai, Sampaio André, Venosa Alessandra, Tauil Pedro, Dias Mirela, Oliveira Carlos
Hospital de Base do Distrito Federal, University of Brasilia Medical School, Brasilia, Brazil.
Int Tinnitus J. 2010;16(1):8-13.
Our goal was to establish the role of VOR - vestibular ocular reflex - in predicting cerebral death in comatose patients.
Prognosis study based on three concurrent cohorts of comatose patients of known etiology followed until the ultimate outcomes: recovery, vegetative state or death. Sixty comatose patients (Glasgow scale 8 or less) with known causes were studied: 49 males and 11 females; 7 to 83 years old. The cold water vestibular stimulation was performed at the bedside by irrigation with 0o Celsius saline in the external auditory canal during one minute. The reflex was considered present when both eyes deviated toward the stimulated side (19 patients group 1); present but abnormal for irregular unconjugated eye movements (11 patients group 2) or absent (30 patients, group 3).
Group 1 had total recovery in 42%, partial recovery in 37% and cerebral death in 21%. These results were 9%, 18% and 73% for group 2, respectively and group 3 had 100% cerebral death. The difference was statistically significant between groups 1 and 2, 3 (p<0,05 Fischer exact test and X test).
Absence of VOR predicted 100% of cerebral death and VOR present normal predicted 21% of cerebral death in the comatose patients we studied.
我们的目标是确定前庭眼反射（VOR）在预测昏迷患者脑死亡中的作用。
基于三组病因已知的昏迷患者进行预后研究，随访直至最终结局：恢复、植物状态或死亡。对60例病因已知的昏迷患者（格拉斯哥评分8分及以下）进行了研究：男性49例，女性11例；年龄7至83岁。在床边通过向外耳道内灌注0摄氏度的盐水1分钟来进行冷水前庭刺激。当双眼都偏向受刺激侧时，反射被认为存在（19例患者，第1组）；存在但因不规则的非共轭眼球运动而异常（11例患者，第2组）或不存在（30例患者，第3组）。
第1组42%完全恢复，37%部分恢复，21%脑死亡。第2组的这些结果分别为9%、18%和73%，第3组脑死亡为100%。第1组与第2组、第3组之间差异有统计学意义（费舍尔精确检验和X检验，p<0.05）。
在我们研究的昏迷患者中，前庭眼反射缺失预测100%的脑死亡，前庭眼反射正常存在预测21%的脑死亡。
