Freund Brin, Kaplan Peter W
1Johns Hopkins Hospital, Department of Neurology, Baltimore, MD.
2Johns Hopkins Bayview Medical Center, Department of Neurology, Baltimore, MD.
Epilepsy Curr. 2017 Sep-Oct;17(5):265-272. doi: 10.5698/1535-7597.17.5.265.
Prognostication after cardiac arrest often depends primarily on neurological function, and characterizing the extent of neurological injury hinges on neurophysiological testing and clinical neurological examination. The presence of early posthypoxic myoclonus (PHM) following cardiac arrest had been invariably associated with poor outcome, but more recent studies have shown that those with early PHM may survive with good neurological function. Electroencephalographic patterns suggestive of severe brain injury may be more valuable than the presence of PHM itself in portending poor functional status, and phenotyping PHM may also be useful in delineating benign and malignant forms. Patients with early PHM should be evaluated similarly to others who suffer cardiac arrest by using a multimodal approach in determining prognosis until further studies are performed that better characterize early PHM subtypes and their outcomes.
心脏骤停后的预后评估通常主要取决于神经功能，而确定神经损伤的程度则依赖于神经生理学检测和临床神经学检查。心脏骤停后早期出现的缺氧后肌阵挛（PHM）一直与不良预后相关，但最近的研究表明，早期出现PHM的患者可能存活且神经功能良好。提示严重脑损伤的脑电图模式在预示功能状态不佳方面可能比PHM本身的存在更有价值，对PHM进行表型分析也可能有助于区分良性和恶性形式。在进行进一步研究以更好地描述早期PHM亚型及其预后之前，对于早期出现PHM的患者，应采用多模式方法进行评估，这与其他心脏骤停患者的评估方式类似，以确定预后。
