可逆性长期昏迷六例临床报告

目的探讨长期但可逆性非外伤性昏迷患者的临床特点、诊断及治疗方法。方法首都医科大学宣武医院神经内科重症监护病房2005年7月～2008年9月期间入院的745例患者中满足下列条件者入组:(1)入院时昏迷,GCS评分小于或等于8分;(2)非脑外伤、非脑血管病;(3)昏迷,GCS评分小于或等于8分持续时间超过一个月;(4)治疗后意识清醒GCS评分15分,GOS评分大于或等于3分。分析入组患者的临床表现、包括年龄、性别、昏迷持续时间、诊断、高峰时临床表现、实验室、影像学、脑电图检查,治疗及预后。结果入组6例,男性2例,女性4例,年龄16～45岁,平均年龄中位值24.5±10.5岁。3例为单纯疱疹病毒性脑炎、1例巨细胞病毒性脑炎、1例急性缺血缺氧性脑病和1例甲状腺危象性脑病。结论长期可逆性昏迷可能是一种特殊的临床综合征,影响其发生的因素有四:首先是病因及对病因的积极治疗。其次是对非抽搐性惊厥持续状态的及时处理,最好立即脑电图监测,证实后即刻开始抗癫持续状态治疗。三是患者本身对损害因素的易感性,反映出不同的病理生理学过程。最后,神经重症监护病房监测和护理起到关键的作用。

Six clinical reports of persistent but reversible coma

Objective In neurological intensive care unit,nontraumatic and non-cerebrovascular disease coma has a very poor prognosis,even though the consciousness has recovered,functional recovery is usually rare.However,a few patients have good outcome in our unit.This article reports the investigation of these patients.Methods The medical records of all inpatients in our unit during 2005.7~2008.9 was summarized,patients were discriminated according to the standard（1）coma,the Glasgow Coma Scale is 8 or less than 8 on admission;（2）nontraumatic and non-cerebrovascular coma;（3）coma keeps longer than 1 month;（4）better outcome,the Glasgow Coma Scale is 3 or more.The clinical spectrum of patients meeting the standard was evaluated.Results 6 patients met this criteria,4 patients were viral encephalitis including 3 with herpes simplex virus and one with cytomegalovirus leading to nonconvulsive status epilepticus.1 patient was hypoxic-ischemic encephalopathy and 1 was thyroid crisis encephalopathy.conclusion Following factors are responsible for the persistent but reversible coma.Firstly,primary affection should be actively managed.Secondly,nonconvulsive status epilipticus is readily treatable cause,continuous elecroencephalography monitoring should be employed at once.Thirdly,reversibility from coma may reflect the differene in the brain susceptibility to the original insults.Lastly,neurological intensie care unit plays a ery important role in the recoveries of these patients.