Pierce J P, Lyle D M, Quine S, Evans N J, Morris J, Fearnside M R
Office of Smoking and Health, Centres for Disease Control, Rockville, MD.
Brain Inj. 1990 Apr-Jun;4(2):191-7. doi: 10.3109/02699059009026165.
Thirty-one patients who were in coma or persistent vegetative state two weeks after sustaining a severe head injury were entered into a coma arousal programme. The coma arousal protocol called for a sequence of vigorous multisensory stimulations to be applied to the patient by a relative for up to eight hours a day for seven days a week. An independent study team monitored two patient outcomes, the time taken to obey a simple command on two consecutive occasions 24 hours apart and patients' score on the Glasgow Outcome Scale 10-12 months post-injury. Outcomes were compared with an historical reference group chosen from the literature, consisting of 135 similarly classified patients. Differences between the pilot study and the reference group patients on initial characteristics suggested that the pilot study patients might have the more favourable outcomes, independent of treatment effect. The sample size was sufficient to detect a 40% improvement in recovery rate. No significant improvements were noted in either the time to obey a simple command (p greater than 0.2) or in the Glasgow Outcome Scale (p greater than 0.25), although the observed difference in the latter group was 11% in favour of the pilot study patients. This study was unable to find any evidence that coma arousal, for all its arduous patient contact, had a markedly better outcome compared with conventional treatment.
31名重度颅脑损伤两周后处于昏迷或持续性植物状态的患者进入了昏迷唤醒计划。昏迷唤醒方案要求亲属每天对患者进行一系列强烈的多感官刺激，每天最多8小时，每周7天。一个独立的研究小组监测了两项患者预后指标，即相隔24小时连续两次服从简单指令所需的时间，以及受伤后10至12个月患者的格拉斯哥预后评分。将预后结果与从文献中选取的一个历史参照组进行比较，该参照组由135名分类相似的患者组成。初步特征显示，试点研究患者与参照组患者之间的差异表明，即使不考虑治疗效果，试点研究患者可能预后更佳。样本量足以检测出恢复率提高40%的情况。在服从简单指令的时间（p>0.2）或格拉斯哥预后评分方面（p>0.25）均未发现显著改善，尽管后一组观察到的差异为11%，有利于试点研究患者。这项研究未能找到任何证据表明，尽管昏迷唤醒需要与患者进行艰苦的接触，但与传统治疗相比，其预后明显更好。
