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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=1739156050-rW4fZrc3s7J2UZm7KyA7KqGwWut6VkHZ-0-51257fd71dcf2ebef5628c6961f8c5d7)
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=1739156050-5bi3zE2PuulES4jDXQFyCiIx1OzLAyMJ-0-5542738031f4a3692a1c9c3c8b3e00c5)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T9.2_1_7223.jpg?sign=1739156050-TLYFB9DHq1aesquFR0KOdlEOWOGImaow-0-fb2e824240b27b8056e0fee539366fce)
表9.3 昏迷患者的眼征
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T9.3_59631.jpg?sign=1739156050-ROJ4s839OHcRXX6iR6ehRCGKPw5FuP9h-0-788bf3b1af33d4fbb46ee5d441668413)
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=1739156050-7vuvnpOClnAPF7KmvUW6Uq6EO8tm0Pkc-0-0eb504c8f231d4e2856e95b6f46e2fab)
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=1739156050-fBR8LkVyIBV8WUBE7kTFCS2Ot00i61Kp-0-55a62aa37fb15d4ec46285c911ce213a)
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=1739156050-Cz0jDUIoL9ZCvAmU0Aax5t08ro2DpEy5-0-c201669e22a18d113e4c3394c5b970f3)
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=1739156050-5KfShwy6Ej5hyCLIdfv7F0OEHouyuV6L-0-e727e392dec56b5bb20c1be2c205a94e)
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=1739156050-8VaU0fxZDhpvuuz2GY0dLPgKPhLxZ1tx-0-a1cb06c713558260d5f1717fe8376f06)
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=1739156050-s0zmxRo8XCrH010Us5FnPl9Hx4MR9So2-0-cf340808f4affdd8c6a270a917a8b549)
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=1739156050-H1drzDuzyzkz8VlghExaRtHJTdXstmh8-0-f16bce89877ac1b3f33e5ab2e0a7c2ce)
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=1739156050-48HjqhfwxsSaN49yqWqhy7XKRabvqXTF-0-a5c6734224be2dac7199b3721bcb1192)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T9.11_1_59960.jpg?sign=1739156050-QVWCQYlHS2QUcVRDrYiWWNwM8hBPAn03-0-7f5a7b21b039ffbcd354958f74435849)
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