Van de Kelft E, Segnarbieux F, Candon E, Couchet P, Frèrebeau P, Daures J P
Department of Neurosurgery B, Centre Hospitalier Universitaire Guy de Chauliac, Montpellier, France.
Crit Care Med. 1994 Jul;22(7):1108-13. doi: 10.1097/00003246-199407000-00010.
To describe early clinical stages in the recovery of consciousness, using selected items from the Glasgow Coma Scale and the Liège Coma Scale.
Validation cohort study, conducted in a tertiary care center.
Neurosurgical intensive therapy unit in a university teaching hospital.
Patients (n = 137) with traumatic coma who were selected according to the following criteria: a) coma due to blunt head trauma with an initial Glasgow Coma Score of < or = 7; b) admission to the neurosurgical intensive therapy unit within the first 24 hrs after trauma; c) patients > 14 yrs of age; requiring endotracheal intubation, mechanical ventilation, and the administration of drugs; and d) survival period allowing analysis of the recovery of consciousness.
Arousal, as expressed by stimulated opening of the eyes and recorded as a delay in days, was correlated with the appearance of the localized pain response, capacity to obey commands, blink reflex, and the cessation of drugs in three groups of patients. These groups were defined according to the time in which there was an appearance of the stimulated opening of the eyes: < 8 days (group 1); between 8 and 15 days (group 2); and after 15 days (group 3). When the three groups of patients were compared, significant differences existed between the mean delays of appearance of stimulated eye opening and the appearance of the blink reflex. Extubation coincided with the appearance of spontaneous eye opening, with a mean delay of 13.5 days.
This study confirms the classical clinical sequence of arousal and recovery of consciousness, with the appearance of stimulated eye opening and the blink reflex first, followed by spontaneous eye opening, and the capacity to obey commands in intubated, traumatized, coma patients. A direct correlation existed between the delay of arousal and the complete recovery of consciousness. When groups of patients with various mean delays for the appearance of stimulated eye opening are considered, reappearance of the blink reflex did not always coincide with stimulated eye opening, suggesting differing structural and functional brain recovery processes.
运用格拉斯哥昏迷量表和列日昏迷量表中的特定项目，描述意识恢复的早期临床阶段。
在三级护理中心进行的验证队列研究。
大学教学医院的神经外科重症治疗病房。
137例创伤性昏迷患者，入选标准如下：a）因钝性头部创伤导致昏迷，初始格拉斯哥昏迷评分≤7分；b）创伤后24小时内入住神经外科重症治疗病房；c）年龄>14岁；需要气管插管、机械通气及药物治疗；d）生存期允许对意识恢复情况进行分析。
通过刺激睁眼来表示觉醒，并记录为延迟天数，在三组患者中，觉醒与局部疼痛反应的出现、服从指令的能力、眨眼反射以及药物停用相关。这三组根据刺激睁眼出现的时间定义为：<8天（第1组）；8至15天（第2组）；15天之后（第3组）。比较这三组患者时，刺激睁眼出现的平均延迟与眨眼反射出现的平均延迟之间存在显著差异。拔管与自主睁眼的出现同时发生，平均延迟为13.5天。
本研究证实了意识觉醒和恢复的经典临床顺序，即对于插管的创伤性昏迷患者，首先出现刺激睁眼和眨眼反射，随后是自主睁眼以及服从指令的能力。觉醒延迟与意识完全恢复之间存在直接关联。当考虑刺激睁眼出现平均延迟不同的患者组时，眨眼反射的再次出现并不总是与刺激睁眼同时发生，这表明大脑的结构和功能恢复过程存在差异。
