Jennett B, Teasdale G
Lancet. 1977 Apr 23;1(8017):878-81. doi: 10.1016/s0140-6736(77)91201-6.
Features of coma during the first week after sever head injury were analysed in 700 patients. Coma is best defined as inability to obey commands, to speak, or to open the eyes. If eye opening is omitted from the definition then some less severly affected patients will be included in the early stages, the duration of coma will be overestimated, and in the later stages the distiction between coma and other unresponsive states may be blurred. Other features which correlate with responsiveness (as judged by motor response, speech, and eye opening) are pupil reactions and eye movements; respiratory abnormalities are less common and less closely related to other aspects of severity. A rigorous fefinition of coma is necessary for valid commparisons between individual patients and between different series of patients with head injury. This is essential for the assessment of alternative management regimens and for establishing predictive criteria.
对700例严重颅脑损伤患者伤后第一周内的昏迷特征进行了分析。昏迷最好定义为不能听从指令、不能说话或不能睁眼。如果从定义中省略睁眼这一项，那么在早期阶段会纳入一些病情较轻的患者，昏迷持续时间会被高估，而在后期阶段，昏迷与其他无反应状态之间的区别可能会变得模糊。其他与反应性相关的特征（通过运动反应、言语和睁眼来判断）是瞳孔反应和眼球运动；呼吸异常较少见，且与严重程度的其他方面关系不太密切。对昏迷进行严格定义对于个体患者之间以及不同系列颅脑损伤患者之间的有效比较是必要的。这对于评估替代治疗方案和建立预测标准至关重要。
