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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=1738810931-bTRx5WtaGTJSrG1ewhv6Upcw822aXN2I-0-295721540023fc321f1407f40b6e76a1)
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=1738810931-ldDptZMqYbQExFQ1iSAdlDQq1PoLr3sK-0-be017d27fa5a14ef5e5868551f2addbb)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T9.2_1_7223.jpg?sign=1738810931-1ecETF29IUYOP7BIOFjY83R8bV6AGyx7-0-3f56519e028488aab86f70b82fc91c55)
表9.3 昏迷患者的眼征
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T9.3_59631.jpg?sign=1738810931-jMLhrjO80fqOAWZkTCsvwXkobK709GyM-0-bb5bbca5bf317299f41c23c543bf2e7b)
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=1738810931-KPHKRTYDhUYlFX0Muu45zKC7tiqu5Xka-0-2e669e6efcd359897db165b08cbc1837)
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=1738810931-yKRdAGQf4O6N6roSTiCHCDlzN9dkGcJ1-0-6e35a3acd5aa2ad135ef2a4ac74c9fe7)
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=1738810931-tIYawKHUcGrJ0g3iiTrO7QjtT5rXk9va-0-1908cf02042e2e2dafdf96741117ae35)
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=1738810931-WKXAuTCOA2rtr2pNCePwkfQBjBRye8xC-0-0d638005becc7c6d59a0e0728933629a)
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=1738810931-IU2PAAtWqtdFY36IBMiCVLi1EmAWOfSE-0-67c9622c6150ec37c819e4d90329a711)
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=1738810931-XBIGjqQNUENXR0PDVsvKfFh8eOUrlkK3-0-d1eac0291cb87078af13bac5b2ded0f0)
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=1738810931-dprg1e2ZkBMs5HbHX62MudZq9igjcpiw-0-ef048b96de4a92b0b7c9140b145ff1ff)
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=1738810931-Xw1lzBdovv6vY0JPiznsKf8Roei9trRh-0-147ebb047fbac96697c063bfdfc27d78)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T9.11_1_59960.jpg?sign=1738810931-ZOJhzP0o6TqCwowCyvucI52fbU6V5VXU-0-1697a74d57dcebcd9015006c7bdc039a)
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