Wijdicks E F M
Division of Critical Care Neurology, Mayo Clinic and Neurosciences Intensive Care Unit, Mayo Clinic Campus, Saint Marys Hospital, Rochester, MN, USA.
Handb Clin Neurol. 2017;140:117-129. doi: 10.1016/B978-0-444-63600-3.00008-8.
Coma has many causes but there are a few urgent ones in clinical practice. Management must start with establishing the cause and an attempt to reverse or attenuate some of the damage. This may include early neurosurgical intervention, efforts to reduce brain tissue shift and raised intracranial pressure, correction of markedly abnormal laboratory abnormalities, and administration of available antidotes. Supporting the patient's vital signs, susceptible to major fluctuations in a changing situation, remains the most crucial aspect of management. Management of the comatose patient is in an intensive care unit and neurointensivists are very often involved. This chapter summarizes the principles of caring for the comatose patient and everything a neurologist would need to know. The basic principles of neurologic assessment of the comatose patient have not changed, but better organization can be achieved by grouping comatose patients according to specific circumstances and findings on neuroimaging. Ongoing supportive care involves especially aggressive prevention of medical complications associated with mechanical ventilation and prolonged immobility. Waiting for recovery-and many do- is often all that is left. Neurorehabilitation of the comatose patient is underdeveloped and may not be effective. There are, as of yet, few proven options for neurostimulation in comatose patients.
昏迷有多种病因，但在临床实践中有一些紧急病因。治疗必须从确定病因开始，并尝试逆转或减轻部分损害。这可能包括早期神经外科干预、努力减少脑组织移位和降低颅内压、纠正明显异常的实验室检查异常，以及使用现有的解毒剂。支持患者的生命体征，因为在病情变化时生命体征容易出现大幅波动，这仍然是治疗最关键的方面。昏迷患者的治疗在重症监护病房进行，神经重症专家经常参与其中。本章总结了护理昏迷患者的原则以及神经科医生需要了解的所有内容。昏迷患者神经评估的基本原则没有改变，但根据具体情况和神经影像学检查结果对昏迷患者进行分组，可以实现更好的组织安排。持续的支持性护理尤其包括积极预防与机械通气和长期不动相关的医疗并发症。等待恢复——许多患者确实如此——往往是剩下的唯一办法。昏迷患者的神经康复尚不完善，可能也无效。截至目前，昏迷患者的神经刺激几乎没有经过验证的有效方法。
