Margolis L H, Shaywitz B A
Pediatrics. 1980 Mar;65(3):477-83.
The outcome of prolonged, nontraumatic coma (greater than five days) in 16 children is reviewed to determine operational clinical parameters which may assist in both clinical decision making and counseling of parents. The children were evaluated by physical and neurologic examinations and school reports one to five years after coma. Six children are normal, six have minor handicaps (attention deficit disorder, minor motor disorders, mild retardation, personality disorders), and four have sustained major sequelae (severe retardation, uncontrolled seizures, blindness). Anoxia, as an etiology of coma and the need for assisted ventilation, were significant indicators of a less than normal outcome. Our results suggest that elevated intracranial pressure of greater than two days duration and deep coma of greater than two weeks were indicators of an abnormal outcome. In view of the improving technical capability to care for these children, but limited past experience, clearly defined and uniform criteria are needed both to assess children during coma and to evaluate them upon recovery.
回顾了16名儿童长时间非创伤性昏迷（超过5天）的结果，以确定有助于临床决策和向家长提供咨询的实用临床参数。在昏迷后的1至5年，通过体格检查、神经学检查和学校报告对这些儿童进行了评估。6名儿童正常，6名有轻度残疾（注意力缺陷障碍、轻度运动障碍、轻度智力迟钝、人格障碍），4名有严重后遗症（严重智力迟钝、癫痫发作失控、失明）。缺氧作为昏迷的病因以及辅助通气的需求，是预后不良的重要指标。我们的结果表明，持续超过两天的颅内压升高和超过两周的深度昏迷是预后异常的指标。鉴于护理这些儿童的技术能力不断提高，但过去经验有限，需要明确统一的标准，以便在昏迷期间评估儿童，并在康复后对其进行评估。
