Wijdicks E F, Parisi J E, Sharbrough F W
Department of Neurology (Neurology Critical Care Service), Mayo Clinic, Rochester, MN 55905.
Ann Neurol. 1994 Feb;35(2):239-43. doi: 10.1002/ana.410350219.
Generalized myoclonus status is common in comatose patients after cardiac resuscitation, but its prognostic value is uncertain. We studied the clinical, radiologic, and pathologic findings in 107 consecutive patients who remained comatose after cardiac resuscitation. Myoclonus status was present in 40 patients (37%). Features more prevalent in patients with myoclonus status were burst suppression on electroencephalograms, cerebral edema or cerebral infarcts on computed tomography scans, and acute ischemic neuronal change in all cortical laminae. All patients with myoclonus status died. Of 67 patients without myoclonus, 20 awakened. We conclude that myoclonus status in postanoxic coma should be considered an agonal phenomenon that indicates devastating neocortical damage. Its presence in comatose patients after cardiac arrest must strongly influence the decision to withdraw life support.
全身性肌阵挛状态在心脏复苏后的昏迷患者中很常见，但其预后价值尚不确定。我们研究了107例心脏复苏后仍昏迷的连续患者的临床、放射学和病理学表现。40例患者（37%）存在肌阵挛状态。肌阵挛状态患者中更常见的特征包括脑电图上的爆发抑制、计算机断层扫描上的脑水肿或脑梗死，以及所有皮质层的急性缺血性神经元改变。所有有肌阵挛状态的患者均死亡。在67例无肌阵挛的患者中，20例苏醒。我们得出结论，缺氧后昏迷中的肌阵挛状态应被视为一种濒死现象，表明新皮质遭受严重损害。心脏骤停后昏迷患者中出现这种情况必然会对撤除生命支持的决定产生重大影响。
