Ireland A J, Grant P T
Accident and Emergency Department, Western Infirmary, Glasgow, UK.
J Accid Emerg Med. 1994 Sep;11(3):206-8. doi: 10.1136/emj.11.3.206.
Two cases of alcoholic coma are presented where extensor responses to noxious stimuli are demonstrated. Decerebrate posturing normally indicates severe structural or functional depression of midbrain function but can be caused by depressant drugs. Blood alcohol measurements are a vital test in the comatose patient as the clinical picture may be caused, or temporarily significantly worsened, by severe alcohol intoxication. The preservation of pupillary light reflexes in the presence of deep coma with decerebrate posturing should alert the clinician to a possible metabolic cause for the coma, including alcohol. Nevertheless, a diagnosis of alcoholic coma should not be made unless the blood alcohol concentration is grossly elevated and other causes of coma have been excluded by careful physical examination, blood glucose and electrolyte measurement, skull radiography and, in the absence of a rapid improvement, computerized tomography.
本文报告了两例酒精性昏迷病例，其中对有害刺激表现出伸肌反应。去大脑强直姿势通常表明中脑功能严重的结构或功能抑制，但也可能由抑制性药物引起。血液酒精检测对于昏迷患者至关重要，因为严重酒精中毒可能导致临床表现，或使其暂时显著恶化。在伴有去大脑强直姿势的深度昏迷情况下，瞳孔对光反射的保留应提醒临床医生注意昏迷可能存在的代谢原因，包括酒精。然而，除非血液酒精浓度大幅升高，且通过仔细的体格检查、血糖和电解质测量、颅骨X线摄影以及在无快速改善情况下进行的计算机断层扫描排除了其他昏迷原因，否则不应诊断为酒精性昏迷。
