Disturbances of Consciousness 意识障碍

Definition of consciousness 意识定义 Consciousness is the general functions of the whole brain 是大脑高级神经中枢功能活动的综合表现 Awareness of self and environment 是人对周围环境及自身状态的识别和察觉能力

The components of consciousness 意识组成 Contents of consciousness perception, emotion, intellection, behavior (the function of cortex) 意识内容 知觉、情感、意志、行为等（皮层功能） States of awareness maintaining the alert state (the function of reticular activating system) i觉醒状态 维持觉醒状态（投射系功能）

Maintaining of consciousness 意识维持 Cerebral hemispheres internal sensory 内感觉冲动 大 脑 皮 层 Brainstem reticular formation 脑干网状结构 Thalamus 丘 脑 external sensory 外感觉冲动

Disturbances of consciousness 意识障碍

Etiology 病 因  Sever systemic infections 重症感染 Metabolic disturbances 内分泌及代谢障碍  Cardiovascular diseases 心血管疾病  Imbalance of fluid and electrolyte 水电解质平衡紊乱 Intoxications 外源性中毒  Physical injury or anoxia 物理或缺氧性损害  Intracranial diseases except infection 颅内非感染性疾病 Etiology 病 因

Somnolence 嗜 睡 Confusion 意 识 模 糊 Stupor 昏 睡 Coma 昏 迷 Delirium 谵 妄 Clinical features 临床表现 Somnolence 嗜 睡 Confusion 意 识 模 糊 Stupor 昏 睡 Coma 昏 迷 Delirium 谵 妄

Somnolence 嗜 睡  Light degree of disorders of consciousness 最轻意识障碍  An inability to sustain a wakeful state 病理性倦睡，持续睡眠  Slow arousal elicited by speaking to patient or applying a tactile stimulus , response to spoken commands is correct. 可被唤醒，并能正确回答问题，做出各种反应  The patient is asleep again without stimulus 刺激除去后又再入睡

Confusion 意识模糊 Being in deeper degree of disturbance of consciousness than somnolence 比嗜睡深  Keeping simple mental functions 能保持简单精神活动 The patient is disorientation 定向力发生障碍

stupor 昏 睡  Near to be unconscious 接近不省人事  Patient can be roused only by vigorous and repeated stimuli, when left unstimulated, quickly drift back into a sleep-like state 强刺激可被唤醒，但很快入睡  Response to spoken commands is absent and inadequate during arousal 醒时回答问题模糊或答非所问

Coma 昏 迷  Serious disturbance of consciousness 严重的意识障碍 The patient is incapable of being aroused by external external stimuli or inner need 任何刺激不能使意识障碍程度减轻或转为清醒  It can be divided three stages 分为三阶段

Three stages of coma 昏迷三阶段 Ⅰmild coma or semicoma Vigorous stimulation may cause a stirring or moaning, reflexes are preserved, ocular movements are obtainable. 轻度昏迷：对疼痛刺激有反应，反射存在，眼球可转动 Ⅱmoderate coma Vigorous stimuli may cause defensive reaction, but the corneal reflex and pupillary reflex are decreased without rotation in eyeballs 中度昏迷：剧烈刺激可有防御反应，角膜反射减弱，瞳孔反射迟顿，眼球无转动 Ⅲdeep coma Tone in limb muscles is diminished, no reaction of all kind is obtainable, all reflexes are in abeyance and vital signs are not stable. 重度昏迷：全身肌肉松驰，对各种刺激全无反应，深浅反射均消失，生命体征不平稳

Delirium 谵 妄  An acute confusional state is characterized by increasing excitability 兴奋性增高为主的高级神经中枢急性活动失调状态  There is manifest reduction in alertness and psychomotor activity with disturbance of orientation 意识清晰度下降，定向力障碍  Prominence of vivid hallucinations and illusions 感觉错乱（幻觉、错觉） Overactivity, tremulousness, confused language 躁动不安，言语杂乱

Concomitant syndromes are very important to determine the causes of coma 伴随症状对于病因定性至关重要 with fever 伴发热 with bradypnea 伴呼吸缓慢 with bradycardia 伴心动过缓 with pupil dilation 瞳孔散大 with miosis 瞳孔缩小 with hypertension 伴高血压

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