Most of the patients in persistent vegetative state are late stage patients for inpatient management, and the medical staff basically understands the etiology, degree of coma, duration of coma, vital signs and general condition of the patient. However, systemic neurological and ancillary examinations should still be performed in patients who are first seen in order to make the correct diagnosis and management as soon as possible. In recent years, patients resuscitated from cardiac respiratory arrest, although timely resuscitation at the scene, rapid operation, high-tech monitoring wards, rapid and timely life support treatment have improved the efficacy, but the mortality rate of comatose patients after resuscitation is still as high as 60%, and 20-40% of surviving patients are combined with varying degrees of sequelae. The mortality rate of patients in persistent vegetative state with severe craniocerebral injury and cerebrovascular disease is still as high as 70-90%.
Persistent vegetative state is caused by various etiologies, including heavy cranial injury, cerebrovascular disease, various toxicities, cerebral ischemic and hypoxic diseases, central nervous system infections and chronic metabolic encephalopathy. Domestically, such patients are mainly distributed within hospitals in large and medium-sized cities in large numbers. Although each country has its own diagnostic criteria, the basic contents and concepts are still more consistent.
I. Walshe criteria.
1. Automatic eye opening and eye opening under verbal stimulation.
2. There is a sleep-wake cycle.
3.Maintain blood pressure and respiration.
4.Lack of locomotor response.
5.Inability to understand words or signals.
6.Inability to execute commands.
7.No discrete locomotor response.
Dougherty criteria
1.Able to open eyes automatically and have sleep-wake cycle.
2.No discrete locomotor response.
3.Maintain blood pressure and regular breathing.
4.Inability to express comprehensible words.
5.Inability to execute commands.
6.No persistent eye tracking movement.
C. U.S. Child Site Pathology Criteria
1.Awareness but no recognition.
2.Able to open eyes but loss of consciousness.
3.No “random” activity or behavior.
4.No “awareness” response.
5.No “casual” language.
6.Inability to execute commands.
7.Spontaneous eye movements, but no continuous tracking.
8. Normal brainstem reflexes and sleep-wake cycle.
9.Autonomous respiration, but chewing and swallowing are impaired.
10. Urinary and fecal incontinence.
The Multi-Society Task Force of PVS
1.Patients cannot perceive themselves and their surroundings, and cannot communicate with each other.
2. No continuous, repetitive, purposeful or random behavioral response to audio-visual, tactile or noxious stimuli.
3. The patient cannot understand or express language.
4.There is a sleep-wake cycle.
5. Under medical and nursing care, there is complete preservation of the autonomic function of the hypothalamus and brainstem.
V. American Congress of Rehabilitation Medicine Criteria
1.Eyes open automatically or after stimulation.
2.Inability to execute commands.
3.Inability to speak or produce understandable words.
4.Lack of continuous visual tracking movement when holding the eyes open with hands, and the eyes do not turn more than 45 degrees in each direction.
VI. Japanese Ota criteria
1.There is a sleep-wake cycle.
2.There is a weak response to harmful stimuli.
3.Normal vegetative nerve function.
4.Incontinence of urine and stool.
5. Bedridden.
6. Gastric tube nutrition.
The Ota standard classifies PVS into three types: complete PVS, incomplete PVS, and transitional PVS. IVS occurs when the patient has an emotional response or an eye chase, and TVS occurs when the patient has a nodding response or closes his eyes or opens his mouth as specified and is able to give a single verbal utterance.
VII. Diagnostic criteria for vegetative state formulated by the Chinese Medical Association Emergency Medicine Branch in China
1.Loss of cognitive function, no conscious activity, and inability to execute commands.
2.Maintain voluntary breathing and blood pressure.
3.Sleep-wake cycle.
4.Inability to understand and express language.
5.Can open the eyes automatically or under stimulation.
6.May have purposeless eye tracking movement.
7.The hypothalamus and brainstem functions are basically preserved.