颅脑损伤后长期昏迷患者的催醒治疗体会

目的探讨46例颅脑损伤后长期昏迷患者的催醒治疗方法。方法46例颅脑损伤后长期昏迷患者应用催醒药物、各种催醒训练的康复治疗和高压氧治疗等。结果46例颅脑损伤后长期昏迷患者中恢复良好13．0％，中残37．0％，重残19．6％，持续性植物生存状态10．9％，死亡率19．6％。结论对颅脑损伤后长期昏迷患者不应放弃治疗，应尽早采取综合治疗措施行催醒治疗。     

重型颅脑损伤后长期昏迷24例的治疗报告

重型颅脑损伤后长期昏迷２４例的治疗报告空军４５７医院神经外科陶红兵，郑浩陆，戴先前等报道重型颅脑损伤后长期昏迷病人２４例，其中男１８例，女６例，年龄８～６７岁，平均４０．２岁．２４例均经头颅ＣＴ扫描证实为重型颅脑损伤，伤后均持续昏迷其中２０例昏迷时间...     

脑外伤长期昏迷病人促醒治疗

目的 探讨脑外伤长期昏迷病人促醒途径。方法 自1986年5月～1999年12月，对142例严重脑外伤病人集中后续治疗，并进行头颅CT、MRI、脑干诱发电位及脑电功率谱随访研究。结果 102例(71．83％)在经过平均92天的昏迷期(30天～36个月)后恢复意识，其中25例(24．5％)恢复工作或学习，生活自理52例(51％)及25例仍需他人照料。结论 认为脑外伤长期昏迷病人经过积极治疗后，其中部分病人可望恢复意识，头颅CT、MRI、脑干诱发电位及脑电功率谱能从不同角度对脑外伤长期昏迷预后估价提供明确客观指标。     

经皮内镜胃造瘘肠内营养的神经外科昏迷患者16例长期随访

神经外科长期昏迷患者病程长、并发症多,合理的营养支持治疗是保障患者生命和康复的基础,经皮内镜下胃造瘘术(percutaneous endoscopic gastrostomy,PEG)自1980年由Gauderer等[1]首次报道以来,已成为长期肠内营养支持的重要方法,本文对16例经皮内镜胃造瘘的神经外科昏迷患者进行长期随访分析.     

急性颅脑损伤导致昏迷的救治

<正>外伤性昏迷的早期治疗,特别是脑外伤患者在ICU阶段,在重症监护的时候,就已经考虑意识状况的变化,已经实施对意识障碍的干预。2015年第8期的《中华神经外科杂志》发表了一个颅脑创伤长期昏迷诊治的中国专家共识。这个专家共识是4月份在昆明举办的第七届颅脑创伤论坛上,到会的70余名专家最后做的一个定稿,其意义在于唤起大家对脑外伤昏迷患者的一个关注。如果一个外伤的患者,预后是一个植物状态或者长期昏迷,那么神经     

关于植物状态病人的神经康复治疗

神经康复学在承担严重的、不同原因引起的植物状态，长期昏迷，低反应状态病人的治疗及护理上占有重要地位，特别是在植物状态病人的康复上，究竟能不能康复，如何康复，仍然是令人困惑的问题。本文以植物状态病人的神经康复治疗为中心作一综述。对植物状态及昏迷、低反应...     

神经外科长期昏迷患者不切开气管防治肺部感染

本组对214例重型颅脑损伤、脑出血长期昏迷患者进行诊治,未行气管切开术,采用综合治疗方法预防肺部感染,收到良好疗效,现报告如下。     

重型颅脑损伤大骨瓣开颅减压术后的远期疗效分析

目的探讨标准外伤大骨瓣开颅术治疗重型颅脑损伤的远期效果。方法回顾性分析167例采用标准外伤大骨瓣开颅术治疗的重型颅脑损伤病人（大骨瓣组）的远期疗效，与采用常规开颅术治疗的42例病人（对照组）进行对比。结果大骨瓣组随访期内死亡21例，发生长期昏迷31例，慢性脑积水142例，脑穿通畸形43例，硬膜下积液145例，迟发性癫痫58例，颅脑损伤后综合征55例。对照组死亡10例，发生长期昏迷4例．慢性脑积水20例，脑穿通畸形7例，硬膜下积液30例，迟发性癫痫15例，颅脑损伤后综合征18例。大骨瓣组病死率低于对照组（P〈0．05），长期昏迷、慢性脑积水、脑穿通畸形和颅脑损伤后综合征发生率高于对照组（P〈0.05）。结论采用大骨瓣开颅减压术治疗重型颅脑损伤，远期病死率较低：早期昏迷发生率虽有所增加．但复苏率明显高于对照组；慢性脑积水、脑穿通畸形发生率增加．但通过采取积极治疗，如早期颅骨成形、脑脊液分流术等可获得较好的疗效，因而远期生活质量较对照组好．     

电针及高压氧对重型颅脑外伤昏迷患者促醒疗效观察

正重型颅脑外伤后昏迷是颅脑损伤后重建的并发症,虽经积极的急诊处理,患者仍然长期处于昏迷状态,严重影响患者的生存状态及社会负担。除了药物治疗外,还有针灸及高压氧等康复措施。但是对于针灸及高压氧等辅助治疗措施的优劣却知之较少,本科尝试在药物治疗的基础上,分别给予针灸及高压氧的辅助刺激措施,初步研究各自的治疗效果,为临床有效的选择提供依据。本科自2013年1月至2015年12月对     

53例重型颅脑损伤长期昏迷病人的催醒效果

目的 介绍53例重型颅脑损伤持续昏迷1个月以上病人的催醒效果和影响催醒效果的因素。方法 伤后昏迷时间1～12个月、GCS≤8分的重型颅脑损伤病人53例，采用高压氧、理疗、药物等综合催醒方法治疗。结果 53例长期昏迷病人中，28例苏醒(52．8％)。按照GOS评分，28例清醒病人中仅6例恢复良好和中残(21．4％)，其他22例病人为重残、无自主生活能力(78．6％)。苏醒成功率与病人是否有原发性脑干伤、脑疝、GCS评分、年龄等冈素有关。结论 采用综合催醒方法，能提高长期昏迷病人苏醒成功率，但神绛功能恢复仍十分闲难。     

Value of electroencephalographic serveillance in the framework of resuscitation in coma caused by acute drug intoxication

The authors carried out long-term clinical and E.E.G. studies on 100 cases of acute drug poisoning. They made the following conclusions: - in unexplained coma, the E.E.G. can indicate toxic aetiology and may sometimes even suggest which drug is responsible, especially for certain chemical groups (barbiturates, phenothiasines, benzodiazepines); - the E.E.G. picture contributes a valuable indication of the depth of coma; the way in which it evolves affects the prognosis; - the effectiveness of therapy may be judged by monitoring cerebral electrical activity.     

Etiology of a short-term mortality in the group of 750 patients with 920 episodes of status epilepticus within a period of 10 years (1988–1997)

PurposeTo determine the etiology of short-term mortality in patients with status epilepticus (SE).Methods920 episodes of SE were recorded among 750 patients in a 10-year period. According to the clinical assessment, sequence of events that led to death in a particular case showed two major causes of death: (1) underlying disease, and (2) complications caused by convulsions, therapy or coma.ResultsAmong 920 episodes of SE, 120 (13%) patients passed away. 79 patients (65.8%) died due to the underlying disease and 27 patients (22.5%) died of the combination caused by complications of underlying disease, convulsions, therapy, and/or coma. Among remaining 14 patients (11.7%), underlying disease was not the cause of death. Those 14 patients suffered complications caused by convulsions, therapy, and coma which caused death in four; therapy and coma in three; therapy in three; coma in two; and convulsions and coma in two patients, in the order already mentioned.ConclusionsAmong approximately 9 out of 10 patients with SE, death was the result of underlying disease. Although with very few patients, additional factors could provoke fatal complications of SE. In case of 1 among 10 patients complications caused by coma, therapy, and/or convulsions were the immediate cause of death. In case of such patients timely and adequate treatment could prevent death.     

Prognosis of patients in coma after acute subdural hematoma due to ruptured intracranial aneurysm

Acute subdural hematomas (aSDH) secondary to intracranial aneurysm rupture are rare. Most patients present with coma and their functional prognosis has been classically considered to be very poor. Previous studies mixed good-grade and poor-grade patients and reported variable outcomes. We reviewed our experience by focusing on patients in coma only and hypothesized that aSDH might worsen initial mortality but not long-term functional outcome. Between 2005 and 2013, 440 subarachnoid hemorrhage (SAH) patients were admitted to our center. Nineteen (4.3%) were found to have an associated aSDH and 13 (2.9%) of these presented with coma. Their prospectively collected clinical and outcome data were reviewed and compared with that of 104 SAH patients without aSDH who presented with coma during the same period. Median aSDH thickness was 10 mm. Four patients presented with an associated aneurysmal cortical laceration and only one had good recovery. Overall, we observed good long-term outcomes in both SAH patients in coma with aSDH and those without aSDH (38.5% versus 26.4%). Associated aSDH does not appear to indicate a poorer long-term functional prognosis in SAH patients presenting with coma. Anisocoria and brain herniation are observed in patients with aSDH thicknesses that are smaller than those observed in trauma patients. Despite a high initial mortality, early surgery to remove the aSDH results in a good outcome in over 60% of survivors. Aneurysmal cortical laceration appears to be an independent entity which shows a poorer prognosis than other types of aneurysmal aSDH.     

Short- and long-term prognostic value of the electroencephalogram in children with severe head injury

To determine the prognostic value of the EEG in severely head-injured children, 24 patients were studied for 8-36 months. During coma, 4 EEG patterns were found: borderline, sleep-like, changeable and slow monotonous (SM). For the short-term prognosis, we conclude that the SM pattern (12/24 patients) indicates a bad prognosis because it was associated with a longer coma and awakening period than that of other EEG patterns and because it was observed in the 3 patients who died from brain injury. In contrast, we describe a 'prewake' pattern (11/22 survivors) which, when it occurs, always announces the onset of a complete awakening. For the long-term prognosis, only 50% of the survivors who had an SM pattern during coma have as good an intellectual and motor outcome as the survivors who displayed other EEG patterns. No other EEG features recorded during coma have short- or long-term prognostic significance.     

A new aid to insulin coma therapy

Summary A new method of controlling insulin coma has been developed. It lessens some of the difficulties which have complicated deep insulin coma therapy.     

Management of the patient with diminished responsiveness

This article provides a comprehensive overview of the management of patients with coma. The article begins with a discussion of the emergency management of patients presenting with an acute alteration in the level of consciousness. It then reviews concepts on supportive care that are necessary to reduce secondary neurologic injury. A third section addresses management according to the underlying cause of coma, with emphasis on diagnoses that are frequently encountered. Issues related to the long-term management of patients in coma and outcome prediction are briefly discussed.     

The use of hyaluronidase with insulin in insulin coma therapy

Summary A study of the use of hyaluronidase in conjunction with insulin, in deep coma insulin therapy, has been described. Fifty-one patients participated in this project—24 men and 27 women. Six patients were refractory to insulin; 12 were started on insulin coma therapy at the beginning of the study. Fifty-one received the mixture of insulin plus hyaluronidase for one month, during different phases of their treatment. A total of 2,968 injections of insulin were given. The property of hyaluronidase to reduce the number of spontaneous convulsions during insulin coma therapy, is pointed out. Alidase, a brand of hyaluronidase, was used in this project.     

Delayed-onset encephalopathy and coma in acute organophosphate poisoning in humans

The objective of the study was to describe the clinical characteristics and course of delayed-onset organophosphate (OP) poisoning. In our clinical experience, we have noticed patients with onset of deep coma 4-7 days after hospital admission, clinical features that have not been previously described. We set up a prospective observational study over 1 year to formally characterize this observation. Thirty-five patients admitted to the intensive care unit (ICU) with severe OP poisoning and treated with atropine and supportive therapy were followed up. Oximes were not administered. Three patients developed delayed-onset coma after presenting with normal or near normal Glasgow coma score (GCS). They developed altered conscious state rapidly progressing to deep coma, 5.0+/-1.0 (mean+/-S.D.) days after OP ingestion. The GCS persisted at 2T for 4.3+/-2.1 days despite the cessation of sedative drugs at the onset of coma. During this period, the patients had miosed non-reacting pupils and no clinically detectable cortical or brainstem activity. Computed tomography of the brain and cerebrospinal fluid analysis were normal. Electroencephalogram showed bihemispheric slow wave disturbances. Two patients required atropine during this period to maintain heart rate and reduce secretions. In all three patients, no metabolic, infective or non-infective cause of altered conscious state was identified. With supportive therapy the GCS improved to 10T in 8.0+/-2.0 days. All patients survived to hospital discharge. Three other patients who developed a reduction in GCS (3T-7T) by 4.7+/-1.2 days but not progressing to coma and recovering (GCS 10T) in 3.3+/-0.6 days may have manifested delayed-onset encephalopathy. Delayed-onset coma appears to have a distinct clinical profile and course with complete resolution of symptoms with supportive therapy. Although persistent cholinesterase inhibition is likely to have contributed to the manifestations, the mechanism of coma and encephalopathy need to be explored in further trials. The good outcomes in these patients suggest that therapy should not be limited in OP-poisoned patients developing profound coma or encephalopathy during hospitalization.     

Atropine coma: a historical note

Insulin coma and various types of convulsive therapies were the major biologic treatment modalities in psychiatry before the psychopharmacological era. Except for electroconvulsive therapy (ECT), these methods disappeared from the psychiatric armamentarium after the introduction of psychotropic drugs. Atropine coma therapy (ACT) was one variety of nonconvulsive coma therapy used from the 1950s in a few state mental hospitals in the United States and in several Middle- and Eastern European countries until the late 1970s. In ACT, a coma of 6-10 hours' duration was induced with doses of parenteral atropine sulfate that were hundreds of times greater than the therapeutic dose administered in internal medicine. Although ACT was given to thousands of patients with a variety of diagnoses for nearly 3 decades, it is rarely mentioned, even in papers on the history of psychiatry. The method, indications, contraindications and adverse effects of ACT are summarized together with patients' personal accounts. Hypotheses concerning its mode of action are briefly mentioned. The reasons why ACT never gained wider acceptance are explored in the context of both contemporary psychiatric practice and the broader sociocultural climate of the era.