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9.昏 迷
概 述
昏迷是指对外界各种刺激无反应,伴有运动、感觉、反射功能障碍及大小便失禁等,而生命体征、呼吸、脉搏、血压等存在。昏迷是一种常见的临床表现,不仅见于神经系统的许多严重疾病,如脑梗死、脑出血、重症颅内感染、脑外伤、脑肿瘤,也可由心、肺、肝、肾等重要器官功能严重受损所致。昏迷往往起病急、进展快,常常危及患者的生命或造成严重残疾。以下是对昏迷患者诊治的临床路径。
表9.1 纳洛酮和氟马西尼
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T9.1_59629.jpg?sign=1739586542-f6L2iJQ4ZYUwUB4QFYCQwgFKzFaF0qEe-0-79c4db49ce465c6f745cf43da4eae21e)
表9.2 昏迷患者的评估重点
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T9.2_59630.jpg?sign=1739586542-1PKil1Kz7FGh6013kGX4p83Mqhhlp6gF-0-b23498d20ada0842cdbf177934b9896b)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T9.2_1_7223.jpg?sign=1739586542-rXKfM6s1erMU31aMofKQ1Nh9R0vUUFHs-0-721ac37bd3258dffa75d8c5fe6ddc944)
表9.3 昏迷患者的眼征
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T9.3_59631.jpg?sign=1739586542-q0GVoKJFwy9LlcBUhIc715gHQRpPpk4p-0-3b5bd13e357c5e99a7525577cb04e54a)
表9.4 昏迷患者的紧急检查
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T9.4_7243.jpg?sign=1739586542-B3OX0WMjyoKUvMj7OhrJ6yEpZrH6Q7ZV-0-27a0baf8d6e5a3e15717635a7bdefcec)
表9.5 伴有过度通气的昏迷病因(低PaCO 2)
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T9.5_7295.jpg?sign=1739586542-IaOLIsSPKEdl3CV3diB4NY3Z2v5k6a1h-0-4907f88b5a0f6171778fd532cbead48a)
表9.6 伴颈强直的昏迷病因
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T9.6_7302.jpg?sign=1739586542-mNbo9pLMYs3nyktSNi1Cm6eMLvZfWAxw-0-4fbbb4911bb53780f272a80741e48b79)
表9.7 伴局灶性神经系统体征的昏迷病因
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T9.7_7309.jpg?sign=1739586542-P1qUeskNFaUagWaSHH0IIe1m08O2OzAh-0-5dc90d3658aec9af1ff0f85f83478137)
表9.8 代谢性因素引起的昏迷
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T9.8_59632.jpg?sign=1739586542-ONW7ctACAhisGPGgIfFCWjyc7ahaee0E-0-939d4d2b6208c3602c30fd8a736473b7)
表9.9 可能的原因及治疗
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T9.9_59957.jpg?sign=1739586542-ugJPxoemqqxM7MsqffYhzzInmt8BKHRW-0-efb8a98c4440ddb1d136d4543329ad3e)
表9.10 可能伴有的疾病及原因及处理
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T9.10_59958.jpg?sign=1739586542-ufEizbpaYr80CWt8Ub8jecGIq2Wv3chy-0-57f61bcc879acb4fbca77adbbe831639)
表9.11 格拉斯哥昏迷量表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T9.11_59959.jpg?sign=1739586542-9WmI25AYENtfcUBAbK04MOBbLmqxyzvS-0-fbd032b0dcdd1aadf722309d77e473be)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T9.11_1_59960.jpg?sign=1739586542-btvNbYnz4SSEcNZqw2uAPwYkCto7TU7j-0-2eb8a0381caa7a6e08b928bea35a7626)
注:格拉斯哥昏迷量表(GCS)是目前临床上最常用的一种判定昏迷的方法,主要是根据患者的睁眼反应、语言反应、运动反应3项内容将昏迷程度由轻到重分为4级。正常:15分;轻度昏迷:12~14分;中度昏迷:9~11分;重度昏迷:8分以下。其中4~7分者预后极差,3分者多不能生存