What is the medical definition of a vegetative state?

I believe the following related introduction should be helpful to your question.

What is a vegetable? The general definition of "vegetative state" in the international medical community is "persistent vegetative state", referred to as PVS. The so-called plant survival state is often a long-term disturbance of consciousness caused by craniocerebral trauma or other reasons, such as cerebral ischemia and hypoxia such as drowning, stroke, asphyxia, neurodegenerative changes, etc., which shows that patients do not respond to the environment and completely lose their cognitive ability to themselves and their surroundings; Although the patient can swallow food, fall asleep and wake up, he can't move his limbs at will day and night, and he completely loses his ability to take care of himself. It can retain the basic functions of the organism, such as metabolism, growth and development.

PVS is different from "brain death". "Brain-dead" patients can never survive, and their main characteristics are spontaneous breathing cessation and brain stem reflex disappearance. PVS patients have spontaneous breathing, and their pulse, blood pressure and body temperature are normal, but they have no speech, consciousness and thinking ability. Their "vegetative state" is actually a special coma. Because patients can sometimes open their eyes and look around, they seem to be awake, so they are also called "conscious coma".

What kind of person can be defined as PVS? At present, there are still different opinions in international academic circles. Some people think that they have been in a coma for more than 3 months, others think that they will be in a coma for more than 6 months, but most people insist that they can only be defined as "vegetative" if they are in a coma for more than 12 months.

It can be seen that a large number of patients who wake up and regain consciousness are basically not vegetative in strict scientific definition. There are still few cases of real vegetative awakening. So, how should we define these "vegetarians"? From a medical point of view, these patients are actually "long-term coma" patients.

Coma is clinically defined as an unresponsive state with eyes closed. Coma for more than 1 month is called long-term coma (some people think that it is long-term coma for more than 2 weeks). Long-term coma can also be divided into coma, vegetative state and mild conscious state. If the comatose patient survives, the vegetative state or waking state begins. There are many different opinions about distinguishing between plant state and waking state. The American Academy of Neurology (AAN) proposed that all four criteria and conditions should be met when determining the state of plants: ① there is no evidence to show that they are following orders; (2) There is no understandable verbal response; (3) There is no discernible speech and sign language to express the intention of conversation and communication; (4) There are no signs of directional or voluntary motor response. Mild waking state is defined as: ① repetitive but uncoordinated actions according to orders; (2) There are understandable words; (3) communicate and react through recognizable language or sign language; (4) Respond to positioning or random movement. If any of the above four criteria can be met, the patient can be classified as mild awakening.

It is not a medical miracle that a patient who has been in a coma for a long time wakes up.

The recovery of long-term coma patients is very common in clinic. A retrospective survey data shows that 10%-50% patients who have been in a coma for a long time after craniocerebral trauma can wake up.

At present, there are many specialized rehabilitation units and institutions at home and abroad for the treatment of long-term coma or vegetative state after craniocerebral trauma, and a series of diagnostic criteria and comprehensive treatment measures have been established for patients with long-term coma or vegetative state after craniocerebral trauma. For example, since the establishment of 1977, the International Institute for Coma Rehabilitation (ICRI) in the United States has treated more than 250 vegetative patients, 92% of whom have recovered from a long-term coma, 35% have been able to take care of themselves, 57% have significantly improved their physical, mental and intellectual abilities, and only 4% have not changed. Considering that these patients have been in coma or vegetative state for more than 6 months when they were admitted to hospital, these statistical results are encouraging.

At present, there is no complete answer to the exact mechanism of awakening of patients with long-term coma. 175 patients (male 13 1, female 44) who were comatose for a long time after severe craniocerebral injury were treated with wake-up therapy, 1 10 patients regained consciousness, and most of them regained consciousness within 3 months of coma. Further data analysis shows that whether a long-term coma patient can wake up depends on whether the patient has primary brain stem injury, brain hernia, trauma and age.

Some people think that the recovery of long-term coma patients after craniocerebral injury is a natural recovery process, and the wake-up therapy has no effect. Nevertheless, doctors all over the world have not given up their efforts, insisting on routine rehabilitation training and comprehensive recovery treatment, in order to promote patients who have been in a coma for a long time to wake up. At present, the active methods are: using drugs with nutritional effects on the brain, acupuncture and aromatherapy drugs in traditional Chinese medicine, electrical stimulation, hyperbaric oxygen, music therapy and so on. However, due to the lack of strict randomized, double-blind controlled research on the methods of resuscitation in clinic, so far, no method or drug has been proved or recognized to have a definite effect on the recovery of patients with long-term coma or vegetative state after craniocerebral trauma.

In addition, it is worth pointing out that although these long-term coma patients have successfully recovered, more than 80% of them still have serious brain dysfunction, such as paralysis, language disorder, memory disorder, emotional disorder and so on. It is still a difficult problem for us to fundamentally improve the quality of life and long-term curative effect of patients with long-term coma.

The mystery of the brain needs further exploration.

In the first quarter of the 20th century, the mortality rate of patients with severe craniocerebral trauma was very high, reaching 60%-70%. Most patients died within a few days after injury, which was the direct result of severe trauma, or died of serious complications in the following weeks. With the development of modern medical technology and the progress of emergency care and neurosurgery in treating patients with severe craniocerebral trauma, patients with severe craniocerebral trauma have more chances to survive, and the mortality rate decreases at the rate of every 10 year 10%. However, the following problem is that more and more patients are in a coma or vegetative state for a long time, which brings a series of serious problems to society and family, as well as many social ethics and economic problems.

With the development and progress of medical technology, it is still a great challenge for clinicians to have a scientific and clear understanding of the serious state after craniocerebral trauma, so that patients with craniocerebral trauma can get the best treatment effect, return to society and reduce the burden on society and family.

In the acute stage of craniocerebral trauma, the presumption of long-term treatment prognosis also needs further study and confirmation. The current evaluation methods can not make long-term prognosis judgment for any patients with acute vegetative state. Although it has been shown that patients who are still in a vegetative state after 3 months of brain injury will not recover obviously, there are also some documents reporting that such patients have achieved late recovery. The United States reported that some patients recovered from vegetative state 4-8 months after brain injury, although some people were still severely disabled. It is also reported that there are 1 43-year-old male patients who began to be conscious after 17 months of hypoxic brain injury. Although the patient doesn't know the person in the photo and can't read, he has developed to tell stories and jokes. In addition, in the 5-year follow-up of 30 patients with persistent vegetative state, 5 patients recovered from persistent vegetative state within 1-5 years, although only 2 patients recovered to the level of communication with others. Among them, 1 case is 6 1 year-old female. After subarachnoid hemorrhage, she was in a vegetative state for three years, and then recovered to the level of reading, watching TV, performing simple number addition and subtraction, eating by herself, not needing a wheelchair and speaking fluently.

Human understanding of the brain is far from reaching the level of revealing its mystery, and many things can only be called miracles. The treatment of coma wake-up after craniocerebral trauma is still controversial, and health experts still have differences on the positive role of coma wake-up treatment in improving quality of life. Family members of patients may need more lasting care and support for different degrees of functional and cognitive defects left after craniocerebral trauma. Therefore, any treatment that can help patients recover or improve their vegetative state, no matter how small, is still worth trying to improve the quality of life of patients with craniocerebral trauma and their families.

At present, the recovery treatment and rehabilitation of patients with long-term coma or vegetative state are not well understood, and only a few units and institutions participate in the rehabilitation treatment of such patients. Here, it is still necessary to call on all sectors of society, especially the health administration and decision-making departments, to pay more attention to this treatment field.