Young G Bryan, Owen Adrian M
Continuum (Minneap Minn). 2015 Oct;21(5 Neurocritical Care):1397-410. doi: 10.1212/CON.0000000000000234.
Evaluating patients in the intensive care unit (ICU) with disorders of consciousness has prognostic implications. When brainstem functions are intact, the neurologist must use ancillary testing to help determine prognosis. This article addresses the challenges of arriving at prognoses in patients with hypoxic-ischemic encephalopathy and traumatic brain injury (TBI) and discusses strategies for dealing with these challenges. This has some relevance to other conditions that are capable of causing irreversible brain damage.
Although practice parameters formulated by an American Academy of Neurology (AAN) subcommittee in 2006 were reliable for evaluating patients with hypoxic-ischemic encephalopathy who did not receive hypothermia, the advent of hypothermia has shown that some of these prognostic features were unreliable. Some patients with TBI thought to be vegetative have been found to have cognitive responses. These revelations require neurologists to reconsider prognostic strategies.
To arrive at a more accurate prognosis, it is best to employ multiple pieces of evidence and incorporate the most updated information from the literature. In some cases, newer technologies can provide further insights into cortical function in behaviorally unresponsive patients.
评估重症监护病房（ICU）中意识障碍患者具有预后意义。当脑干功能完好时，神经科医生必须使用辅助检查来帮助确定预后。本文探讨了在缺氧缺血性脑病和创伤性脑损伤（TBI）患者中得出预后结论所面临的挑战，并讨论应对这些挑战的策略。这与其他能够导致不可逆脑损伤的病症也有一定关联。
尽管美国神经病学学会（AAN）一个小组委员会在2006年制定的实践参数对于评估未接受低温治疗的缺氧缺血性脑病患者是可靠的，但低温治疗的出现表明其中一些预后特征并不可靠。一些被认为处于植物状态的TBI患者被发现有认知反应。这些新发现要求神经科医生重新考虑预后策略。
为了得出更准确的预后结论，最好采用多条证据并纳入文献中的最新信息。在某些情况下，新技术可以为行为无反应患者的皮质功能提供进一步的见解。
