昏迷患儿动态观察格拉斯哥昏迷评分的临床意义

Value of Glasgow-Pittsburgh Coma Scale scoring in childhood coma

摘要:

目的：评估格拉斯哥（GCS）和动态格拉斯哥匹斯堡（GCS-P）昏迷评分的临床意义及对昏迷患儿预后的判断价值。方法：收集我院17例具有GCS和GCS-P评分的昏迷患儿临床资料，分析GCS和GCS-P评分、头颅影像学（CT和MRI）及脑电图检查结果，同时观察昏迷患儿GCS-P评分动态变化。结果：7例患儿检查脑电图，4例显示低电位，这4例都预后不良；12例检查头颅CT和MRI，3例显示缺血出血灶其中有2例死亡；GCS和GCS-P评分对预后判断的准确率分别为85.71％和88.57％，错误率分别为14.29％和11.43％；13例患儿进行GCS-P评分动态评估，7例预后良好，曲线呈上升趋势，6例预后不良，曲线呈水平或下降趋势。结论：动态GCS-P评分可以作为评价昏迷患儿预后及功能恢复的客观指标。临床观察结合影像学及电生理检查，将会使脑功能状态的预后判断更趋完善，为临床提供更有价值的信息。

Abstract:

OBJECTIVE: To investigate the value of Glasgow Coma Scale (GCS) and Glasgow-Pittsburgh Coma Scale (GCS-P) scoring in predicting the prognosis of coma in children. METHODS: Clinical data of 17 comatose children were retrospectively reviewed. The results of GCS and GCS-P scoring, electroencephalogram (EEG) and cranial imaging were analyzed. Dynamic curves of GCS-P score were drawn. RESULTS: Seven patients received EEG examination and four showed low potential. The four patients had poor prognosis. Cranial CT and MRI were performed in 12 patients. Of these three showed cerebral hemorrhage and ischemia and had a poor prognosis. The accuracy rate for predicting the prognosis of GCS and GCS-P scoring was 85.71% and 88.57% respectively. A continuous GCS-P scoring was performed in 13 patients. A dynamic GCS-P curve showed an ascent in seven cases with good prognosis but a flat or declined tendency in six cases with poor prognosis. COCLUSIONS: GCS-P scoring is valuable for predicting prognosis in children with coma. Combined with EEG and cranial imaging examinations, the accuracy for predicting prognosis of GCS-P scoring will increase.