对非急性期意识障碍客观评定的研究进展
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摘要
<正>近年来,随着医疗水平的提高,许多严重脑外伤、脑卒中、心跳呼吸骤停等患者得以存活,但均留有不同程度的意识障碍。根据其觉醒和意识内容的程度不同,意识障碍可分为昏迷、植物状态、持续植物状态、最小意识状态等多个水平[1]。虽然意识障碍的分级明确,但植物状态的误诊率依然很高,Childs、Andrews、Laureys等[2—4]分别发现植物状态误诊率为37%、43%、35%。因此,我们需要建立更客观的评定方法来
引文
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[28]邱天明,吴劲松,庄冬晓,等.静态功能磁共振分析方法在脑胶质瘤术前语言皮质定位中的初步应用[J].中华神经外科杂志,2012,(28):1196—1200.
[29]Holeckova I,Fischer C,Morlet D,et al.Subject's own name as a novel in a MMN design:a combined ERP and PET study[J].Brain Research,2008,(1189):152—165.
[30]Staffen W,Kronbichler M,Aichhorn M,et al.Selective brain activity in response to one's own name in the persistent vegetative state[J].J Neurol Neurosurg Psychiatry,2006,77(12):1383—1384.
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[2]Childs NL,Mercer WN,Childs HW.Accuracy of diagnosis of persistent vegetative state[J].Neurology,1993,43(8):1465—1467.
[3]Andrews K,Murphy L,Munday R,et al.Misdiagnosis of the vegetative state:retrospective study in a rehabilitation unit[J].BMJ,1996,313(7048):13—16.
[4]Majerus S,Gill-Thwaites H,Andrews K,et al.Behavioral evaluation of consciousness in severe brain damage[J].Prog Brain Res,2005,(150):397—413.
[5]Jennett B,Plum F.Persistent vegetative state after brain damage:a syndrome in search of a name[J].Lancet,1972,1(7753):734—737.
[6]von Wild K,Laureys ST,Gerstenbrand F,et al.The vegetative state-a syndrome in search of a name[J].Journal of Medicine and Life,2012,5(1):3—15.
[7]Ashwal S,Cranford R,Bernat J,et al.Medical aspects of the persistent vegetative state(1).The Multi-Society Task Force on PVS[J].New England Journal of Medicine,1994,330(21):1499—1508.
[8]Giacino JT,Ashwal S,Childs N,et al.The minimally conscious state:definition and diagnostic criteria[J].Neurology,2002,58(3):349—353.
[9]Faugeras F,Rohaut B,Weiss N,et al.Probing consciousness with event-related potentials in the vegetative state[J].Neurology,2011,77(3):264—268.
[10]Landsness E,Bruno MA,Noirhomme Q,et al.Electrophysiological correlates of behavioural changes in vigilance in vegetative state and minimally conscious state[J].Brain,2011,134(Pt 8):2222—2232.
[11]Kotchoubey B,Veser S,Real R,et al.Towards a more precise neurophysiological assessment of cognitive functions in patients with disorders of consciousness[J].Restorative Neurology and Neuroscience,2013,31(4):473—485.
[12]Rosanova M,Gosseries O,Casarotto S,et al.Recovery of cortical effective connectivity and recovery of consciousness in vegetative patients[J].Brain,2012,135(Pt 4):1308—1320.
[13]Rafii MS,Brewer JB.Functional brain imaging in the clinical assessment of consciousness[J].PLo S Biology,2010,8(11):e1000548.
[14]Wu DY,Cai G,Yuan Y,et al.Application of nonlinear dynamics analysis in assessing unconsciousness:a preliminary study[J].Clinical Neurophysiology,2011,122(3):490—498.
[15]Wu DY,Cai G,Zorowitz RD,et al.Measuring interconnection of the residual cortical functional islands in persistent vegetative state and minimal conscious state with EEG nonlinear analysis[J].Clinical Neurophysiology,2011,122(10):1956—1966.
[16]Perrin F,Schnakers C,Schabus M,et al.Brain response to one's own name in vegetative state,minimally conscious state,and locked-in syndrome[J].Archives of Neurology,2006,63(4):562—569.
[17]Schnakers C,Perrin F,Schabus M,et al.Voluntary brain processing in disorders of consciousness[J].Neurology,2008,71(20):1614—1620.
[18]Fischer C,Luaute J,Morlet D.Event-related potentials(MMN and novelty P3)in permanent vegetative or minimally conscious states[J].Clinical Neurophysiology,2010,121(7):1032—1042.
[19]Duncan CC,Barry RJ,Connolly JF,et al.Event-related potentials in clinical research:guidelines for eliciting,recording,and quantifying mismatch negativity,P300,and N400[J].Clinical Neurophysiology,2009,120(11):1883—1908.
[20]Boly M,Garrido MI,Gosseries O,et al.Preserved feedforward but impaired top-down processes in the vegetative state[J].Science,2011,332(6031):858—862.
[21]Wijnen VJ,van Boxtel GJ,Eilander HJ,et al.Mismatch negativity predicts recovery from the vegetative state[J].Clinical Neurophysiology,2007,118(3):597—605.
[22]Laureys S,Boly M,Maquet P.Tracking the recovery of consciousness from coma[J].Journal of Clinical Investigation,2006,116(7):1823—1825.
[23]Boly M,Faymonville ME,Schnakers C,et al.Perception of pain in the minimally conscious state with PET activation:an observational study[J].Lancet Neurology,2008,7(11):1013—1020.
[24]Bruno MA,Majerus S,Boly M,et al.Functional neuroanatomy underlying the clinical subcategorization of minimally conscious state patients[J].Journal of Neurology,2012,259(6):1087—1098.
[25]Rees G,Edwards S.Is pain in the brain[J]Nature Clinical Practice Neurology,2009,5:76—77.
[26]田雨,马聪,肖恩华,等.脑功能磁共振伦理学问题初探[J].医学与哲学(临床决策论坛版),2011,(32):69—70.
[27]Vanhaudenhuyse A,Noirhomme Q,Tshibanda LJ,et al.Default network connectivity reflects the level of consciousness in non-communicative brain-damaged patients[J].Brain,2010,133(Pt 1):161—171.
[28]邱天明,吴劲松,庄冬晓,等.静态功能磁共振分析方法在脑胶质瘤术前语言皮质定位中的初步应用[J].中华神经外科杂志,2012,(28):1196—1200.
[29]Holeckova I,Fischer C,Morlet D,et al.Subject's own name as a novel in a MMN design:a combined ERP and PET study[J].Brain Research,2008,(1189):152—165.
[30]Staffen W,Kronbichler M,Aichhorn M,et al.Selective brain activity in response to one's own name in the persistent vegetative state[J].J Neurol Neurosurg Psychiatry,2006,77(12):1383—1384.
[31]Di HB,Yu SM,Weng XC,et al.Cerebral response to patient's own name in the vegetative and minimally conscious states[J].Neurology,2007,68(12):895—899.
[32]Monti MM,Vanhaudenhuyse A,Coleman MR,et al.Willful modulation of brain activity in disorders of consciousness[J].New England Journal of Medicine,2010,362(7):579—589.
[33]Owen AM,Coleman MR,Boly M,et al.Response to Comments on“Detecting awareness in the vegetative state”[J].Science,2007,315:1221c—1221c.