重症脑功能损伤的评价  

Evaluation of severe brain impairment

作　　者：宿英英[1] 张艳[1] 赵红[1] 王小梅[1] 华扬[2] 

机构地区：[1]首都医科大学宣武医院神经内科重症监护病房,北京100053 [2]首都医科大学宣武医院医学影像科,北京100053

出　　处：《中华神经科杂志》2003年第6期461-465,共5页Chinese Journal of Neurology

基　　金：北京市科委资助项目 (95 3 3 0 40 0 3 )

摘　　要：目的　探讨重症脑功能损伤准确、客观、可靠的评价方法。方法　采用临床指标和脑电图 (EEG)、脑干诱发电位 (BAEP)、短潜伏期体感诱发电位 (SLSEP)和经颅超声多普勒 (TCD)等实验室评价指标 ,对 2 1例重症脑功能损伤患者进行评定。结果　重症脑功能损伤的主要原因是呼吸心跳骤停、急性低氧血症和低血压休克。 2 1例患者中 ,评定为脑死亡者 7例 ,全部临床评价指标和至少 3项实验室评价指标符合脑死亡判定标准 ,评定后 1～ 18d心跳停止 ;评定为植物生存状态者 7例 ,临床与脑电生理评定结果大致吻合 ,其中 6例大脑半球功能受累较轻 (EEGⅠ级 ) ,脑干功能损伤无一避免 ,主要表现为BAEP的Ⅴ波异常 ;其他 7例中脑功能的临床和实验室评定结果不佳 ,临床死亡 5例 ,另 2例脑干和脊髓活动大多存在 ,EEG、BAEP和SLSEP结果较好 (Ⅰ或Ⅱ级 ) ,分别于 2周和 3个月后意识恢复。结论　临床指标与实验室指标的结合以及实验室指标的相互补充 ,使脑功能判断更加客观、准确、可靠。Objective To investigate the methods for evaluating severe brain impairment accurately and objectively.Methods Using clinical examinations (including conscious state,Glasgow coma score,brain stem reflections,cranial nerve dominated actions,spinal reflections,spinal nerve dominated automatic actions,respiratory and respiratory machine testing) and laboratory methods (such as EEG、BEAP、SLSEP and TCD),21 cases with severe brain impairment were evaluated.Results The main causes of severe brain impairment were respiratory and cardiac arrest,acute hypoxemia and hypotension.Multiple organ dysfunction syndrome (MODS) was determined according to the standard issued by the National Severe Emergency Medicine Congress in 1995.7 cases were determined as brain death presenting with deep coma,disappearance of brain stem reflection and cranial nerve dominated automatic action; spinal reflection completely disappearance in 5 patients and partially in 2 patients,spinal auto-reflection existed in 1 patient,and spinal nerve dominated automatic action disappeared.All clinical evaluations of brain marker and at least 3 laboratory marker were accorded with the determinant standard of brain death.All hearts stopped beating in 1～18 days after evaluation.7 cases were evaluated as remaining in a vegetation state,the clinical presentation including open-eyes coma,partially impaired the brain stem reflection (3 cases) and the cranial nerve dominated action (6 cases),and partially affected the spinal reflection and the spinal nerve dominated auto-action completely disappeared in all 7 patients.All of the presentation and electraphysiological evaluation anastomosed roughly,hemisphere function of 86% cases were impaired (EEG Ⅰgrade),brainstem function of all cases were impaired,and BAEP showing lateral bilateral Ⅴ-wave disappear.Among the remaining 7 cases,5 cases were determined as death by GOS.The brain stem reflection and cranial nerve dominated action disappeared in most of the patients,pressing-orbit reaction disappeared in 3 pati

关 键 词：脑功能损伤 呼吸心跳骤停 急性低氧血症 低血压休克 临床评价指标 脑死亡 

分 类 号：R741[医药卫生—神经病学与精神病学]