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目的探讨准确、可靠、客观的床旁持续植物状态评估方法。方法对34例脑损害后昏迷转为持续植物状态的患者进行脑功能评估。临床指标包括意识状态、7项脑干反射、4项脑神经支配活动、3项脊髓反射、1项脊髓自动反射和2项脊神经支配活动;神经电生理指标包括脑电图(Youg 分级评估标准)、脑干听觉诱发电位和短潜伏期体感诱发电位(Cant 分级评估标准)。结果缺血缺氧性脑损害(30/34,88.2%)是最常见的脑损害原因。意识状态从早期浅度、中度或深度昏迷转为睁眼昏迷,脑干反射和脑神经支配的活动全部或部分存在,肢体自主运动部分存在或消失,脊髓反射全部或部分存在,脊髓自动反射全部或部分存在,脊髓病理反射部分阳性。脑电图判定Ⅰ级和Ⅵ级的分别为64.5%(20/31)和29.0%(9/31),Ⅲ级和Ⅳ级的共6.5%(2/31)。脑干听觉诱发电位判定Ⅰ级、Ⅱ级和Ⅲ级的分别为34.8%(8/23)、21.7%(5/23)和43.5%(10/23)。短潜伏期体感诱发电位判定Ⅰ级和Ⅲ级的分别为43.5%(10/23)和52.2%(12/23),Ⅱ级的仅4.4%(1/23)。全部34例患者中死亡10例(29.4%),在35～90d 内意识清醒者4例(11.8%)。结论临床指标符合持续植物状态患者的脑功能状态存在差异,多项电生理技术的联合可对其做出准确、客观、可靠的评定,并为临床医疗决策提供重要参考意见。
Objective To explore an accurate, reliable and objective bedside plant status assessment method. Methods Brain function was assessed in 34 patients who had a coma after a brain injury and were switched to a continuous vegetative state. The clinical parameters included consciousness status, 7 brainstem reflexes, 4 cerebral innervation activities, 3 spinal reflexes, 1 spinal cord autoreflection and 2 spinal innervations. Neurophysiological parameters included EEG (Youg grading criteria) , Brainstem auditory evoked potentials and short latency somatosensory evoked potential (Cant rating criteria). Results Hypoxic-ischemic brain damage (30 / 34,88.2%) was the most common cause of brain damage. Consciousness from the early shallow, moderate or deep coma into open-air unconsciousness, brainstem reflex and brain innervation of all or part of the existence of limb movement part of the existence or disappearance of all or part of the spinal cord reflex, spinal cord auto-reflex All or part of the existence of spinal cord pathological reflex partial positive. Electroencephalography showed Grade I and VI were 64.5% (20/31) and 29.0% (9/31) respectively, and Grade III and IV were 6.5% (2/31) in total. Brainstem auditory evoked potentials were 34.8% (8/23), 21.7% (5/23) and 43.5% (10/23) in grade I, grade II and grade III, respectively. Short latency somatosensory evoked potentials were 43.5% (10/23) and 52.2% (12/23) for Grade I and III, respectively, and only 4.4% (1/23) for Grade II. Ten patients (29.4%) died in all 34 patients, and 4 (11.8%) were conscious in 35-90 days. Conclusion There are differences in brain functional status among patients with clinical features consistent with persistent vegetative state. The combination of multiple electrophysiological techniques can make an accurate, objective and reliable assessment and provide an important reference for clinical medical decision-making.