Barbiturate 혼수치료에서 환자의 동공 빛 반사의 의의

Abstract

Objective : The aim of this study was to examine the significance of pupillary light reflex (PLR) during barbiturate coma therapy (BCT) against severe brain swelling.

Methods : Between January 2003 and October 2007, 28 patients (traumatic brain injury: 15) underwent BCT because of maintained severe brain swelling after operation. All the patients maintained 3-6th wave per minute activity on electro-encephalography, and PLR were checked every 2 hours during BCT. The patient's performance was checked using Glasgow outcome scale (GOS) at the average 19.6 days (1-60 days) after BCT.

Results :Twenty one patients had PLR at the start of BCT. Among 21 patients, 12 patient's PLR were vanished during BCT. Nine of 12 patients were dead (GOS=1), two had severe disability (GOS=2), and one stayed persistent vegetative state (GOS =3). But other nine patient's group, who showed prompt PLR continuously during BCT, got more improved GOS, compared with PLR vanished patient's group; 7 of 9 patients ranked more than GOS score 3.

Conclusion :Our clinical data suggest that the maintaining prompt PLR during BCT is a positive finding to predict good outcome.