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1、248中华内科杂志2005年4月第44卷第4期ChinJInternMed,April2005,Vol44,No.4论著心肺复苏后昏迷的评估研究宿英英杨庆林庞英吕向平摘要目的探讨准确、客观评估与判定心肺复苏后昏迷的方法。方法对35例心肺复苏后24h仍处于昏迷状态的患者进行前瞻性脑功能状态的动态评估,评估项目包括临床指标、神经电生理指标和脑血流指标。结果35例中深昏迷的24例患者,格拉斯哥昏迷评分均为3分,脑电图除4例外均级,脑干听觉诱发电位(BAEP)除3例外均为级,短潜伏期体感诱发电位(SLSEP)除1例外均
2、为级,全部患者复苏后1个月内死亡。24例中11例(458%)判定为脑死亡,格拉斯哥预后分级(GOS)评为级;其余11例存活患者从昏迷到睁眼昏迷,5例脑电图为级、3例BAEP和SLSEP为级,GOS均为级,其中2例(182%)分别在第35、90天清醒,GOS评为级和级。结论临床与实验室指标相结合综合评定心肺复苏后昏迷更加客观、准确、可靠,并对临床医疗决策和提高脑复苏成功率具有重要的指导意义。关键词心肺复苏术;昏迷;脑死亡EvaluationofcomaaftercardiopulmonaryresuscitationS
3、UYingying,YANGQinglin,PANGYing,LXiangpingDepartmentofNeurology,XuanwuHospital,CapitalUniversityofMedicalSciences,Beijing100053,ChinaCorrespondingauthor:SUYingying,Email:tangsuyingying@yahoocomcnAbstractObjectiveToinvestigatetheaccurateandobjectivemethodsofevaluatin
4、gcomaaftercardiopulmonaryresuscitation.MethodsCasesthatwerestillincoma24hoursaftercardiopulmonaryresuscitationwerecontinuouslyobservedandevaluatedbetweenApril2002andNovemember2004.Themethodsofevaluationincludedvariousclinicalexaminations,forinstanceconsciousstate,Glasgowcomas
5、core(GCS),brainsteminflection,spinalreflexesandsoon.Othermethodsofevaluationincludedlaboratoryexaminations,suchaselectroencephalography(EEG),brainauditoryevokedpotential(BAEP),shortlatentsomatosensoryevokedpotential(SLSEP)andtranscranialdoppler(TCD)Results24ofaseriesof35case
6、s(686%)wereindeepcomaTheGCSisscore3EEGevaluatedwasnotlessthangradeinallexcept4;BAEPevaluatedwasgradeinallexcept3;SLSEPevaluatedwasgradeinallexcept1.24casesdiedwithin1monthand11ofthem(458%)wereevaluatedashavingbraindeathandGlasgowoutcomescore(GOS)wasgrade11ofthe35cases
7、survivedandtheirstateofconsciousnesschangedfromdeepcomatocomavigi,lEEGevaluatedwasgradein5casesBAEPandSLSEPweregradeinthe3casesevaluatedandGOSisgrade.2cases(182%)regainconsciousnessatthetimeof35and90daysaftercardiopulmonaryresuscitationandtheirGOSwasgradeandgraderespect
8、ively.ConclusionCombinedandcontinuousobservationofclinicalma
