Levy D E, Bates D, Caronna J J, Cartlidge N E, Knill-Jones R P, Lapinski R H, Singer B H, Shaw D A, Plum F
Ann Intern Med. 1981 Mar;94(3):293-301. doi: 10.7326/0003-4819-94-3-293.
We conducted serial neurologic examinations on 500 patients in nontraumatic coma to identify factors predicting recovery. Overall, 81 patients (16%) led an independent life at some point within the first year; the remainder either died without recovery from coma (61%), never improved beyond the vegetative state (12%), or regained consciousness but remained dependent on others for daily activities (11%). Functional recovery did not depend on age but was to some degree related to the cause of coma (subarachnoid hemorrhage and other cerebrovascular disease having the worst recovery; hypoxia-ischemia, intermediate; and hepatic and miscellaneous causes, best) and especially to early clinical signs of brain dysfunction. Even within hours of the onset of coma, only one of 120 patients lacking two of corneal, pupillary, and oculovestibular responses ever regained independent function. The study identifies clinical features of comatose patients that appear within the first week and that are important for predicting recovery and designing future therapeutic trials.
我们对500例非创伤性昏迷患者进行了系列神经学检查，以确定预测恢复的因素。总体而言，81例患者（16%）在第一年的某个时间点过上了独立生活；其余患者要么昏迷未恢复而死亡（61%），要么从未改善到植物状态以上（12%），要么恢复意识但日常生活仍依赖他人（11%）。功能恢复不取决于年龄，但在某种程度上与昏迷原因有关（蛛网膜下腔出血和其他脑血管疾病恢复最差；缺氧缺血性，中等；肝性和其他原因，最好），尤其与脑功能障碍的早期临床体征有关。即使在昏迷发作数小时内，120例缺乏角膜、瞳孔和眼前庭反应中的两项的患者中，只有1例恢复了独立功能。该研究确定了昏迷患者在第一周内出现的临床特征，这些特征对于预测恢复和设计未来的治疗试验很重要。
