昏迷指数，是医学上评估病人昏迷程度的指标，现今用的最广的是格拉斯哥昏迷指数（GCS, Glasgow Coma Scale）。此指数是由格拉斯哥大学的两位神经外科教授Graham Teasdale与Bryan J. Jennett在1974年所发表。
评估方法
格拉斯哥昏迷指数的评估有三个方面，三个方面的分数加总即为昏迷指数。记述以E、V、M三方面：
[编辑]睁眼反应（E, Eye opening）
4分：自然睁眼(spontaneous)
3分：呼唤会睁眼(to speech)
2分：有刺激或痛楚会睁眼(to pain)
1分：对於刺激无反应(none)
[编辑]说话反应（V, Verbal response）
5分：说话有条理(oriented)。
4分：可应答，但有答非所问的情形(confused)。
3分：可说出单字(inappropriate words)。
2分：可发出声音(unintelligible sounds)。
1分：无任何反应(none)。
[编辑]运动反应（M, Motor response）
6分：可依指令动作(obey commands)。
5分：施以刺激时，可定位出疼痛位置(localize)。
4分：对疼痛刺激有反应，肢体会回缩(withdrawal)。
3分：对疼痛刺激有反应，肢体会弯曲(decorticate flexion)。
2分：对疼痛刺激有反应，肢体会伸直(decerebrate extension)。
1分：无任何反应(no response)。
[编辑]昏迷程度
昏迷程度以E、V、M三者分数加总来评估，正常人的昏迷指数是满分15分，昏迷程度越重者的昏迷指数越低分。
轻度昏迷：13分到14分。
中度昏迷：9分到12分。
重度昏迷：3分到8分。
he Glasgow Coma Scale or GCS, sometimes also known as the Glasgow Coma Score is a neurological scale which aims to give a reliable, objective way of recording the conscious state of a person, for initial as well as continuing assessment. A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (the more widely used modified or revised scale).
GCS was initially used to assess level of consciousness after head injury, and the scale is now used by first aid, EMS and doctors as being applicable to all acute medical and trauma patients. In hospital it is also used in chronic patient monitoring, in for instance, intensive care.
The scale was published in 1974 by Graham Teasdale and Bryan J. Jennett, professors of neurosurgery at the University of Glasgow. The pair went on to author the textbook Management of Head Injuries (FA Davis 1981, ISBN 0-8036-5019-1), a celebrated work in the field.
GCS is used as part of several ICU scoring systems, including APACHE II, SAPS II, and SOFA, to assess the status of the central nervous system. A similar scale, the Rancho Los Amigos Scale is used to assess the recovery of traumatic brain injury patients.
Elements of the scale
Glasgow Coma Scale
1 2 3 4 5 6
Eyes Does not open eyes Opens eyes in response to painful stimuli Opens eyes in response to voice Opens eyes spontaneously N/A N/A
Verbal Makes no sounds Incomprehensible sounds Utters inappropriate words Confused, disoriented Oriented, converses normally N/A
Motor Makes no movements Extension to painful stimuli Abnormal flexion to painful stimuli Flexion / Withdrawal to painful stimuli Localizes painful stimuli Obeys Commands
The scale comprises three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS (the sum) is 3 (deep coma or death), while the highest is 15 (fully awake person).
[edit]Best eye response (E)
There are 4 grades starting with the most severe:
No eye opening
Eye opening in response to pain. (Patient responds to pressure on the patient’s fingernail bed; if this does not elicit a response, supraorbital and sternal pressure or rub may be used.)
Eye opening to speech. (Not to be confused with an awaking of a sleeping person; such patients receive a score of 4, not 3.)
Eyes opening spontaneously
[edit]Best verbal response (V)
There are 5 grades starting with the most severe:
No verbal response
Incomprehensible sounds. (Moaning but no words.)
Inappropriate words. (Random or exclamatory articulated speech, but no conversational exchange)
Confused. (The patient responds to questions coherently but there is some disorientation and confusion.)
Oriented. (Patient responds coherently and appropriately to questions such as the patient’s name and age, where they are and why, the year, month, etc.)
[edit]Best motor response (M)
There are 6 grades starting with the most severe:
No motor response
Extension to pain (adduction of arm, internal rotation of shoulder, pronation of forearm, extension of wrist, decerebrate response)
Abnormal flexion to pain (adduction of arm, internal rotation of shoulder, pronation of forearm, flexion of wrist, decorticate response)
Flexion/Withdrawal to pain (flexion of elbow, supination of forearm, flexion of wrist when supra-orbital pressure applied ; pulls part of body away when nailbed pinched)
Localizes to pain. (Purposeful movements towards painful stimuli; e.g., hand crosses mid-line and gets above clavicle when supra-orbital pressure applied.)
Obeys commands. (The patient does simple things as asked.)
[edit]Interpretation
Individual elements as well as the sum of the score are important. Hence, the score is expressed in the form "GCS 9 = E2 V4 M3 at 07:35".
Generally, comas are classified as:
Severe, with GCS ≤ 8
Moderate, GCS 9 - 12
Minor, GCS ≥ 13.
Intubation and severe facial/eye swelling or damage, make it impossible to test the verbal and eye responses. In these circumstances, the score is given as 1 with a modifier attached e.g. 'E1c' where 'c' = closed, or 'V1t' where t = tube. A composite might be 'GCS 5tc'. This would mean, for example, eyes closed because of swelling = 1, intubated = 1, leaving a motor score of 3 for 'abnormal flexion'.
The GCS has limited applicability to children, especially below the age of 36 months (where the verbal performance of even a healthy child would be expected to be poor). Consequently the Paediatric Glasgow Coma Scale, a separate yet closely related scale, was developed for assessing younger children.
[edit]Revisions
Glasgow Coma Scale: While the 15 point scale is the predominant one in use, this is in fact a modification and is more correctly referred to as the Modified Glasgow Coma Scale. The original scale was a 14 point scale, omitting the category of 'abnormal flexion'. Some centres still use this older scale, but most (including the Glasgow unit where the original work was done) have adopted the modified one.
The Rappaport Coma/Near Coma Scale made other changes.
参考资料：wiki 自由的encyclopedia