We’ve all seen countless TV shows
在我们看过的许多电视节目中
when a patient falls into a coma,
如果病人陷入昏迷
the weeping family members try everything possible to resuscitate their loved one,
悲痛的病人家属会想尽一切办法让他苏醒
from standing by their side and reading them stories to playing their favorite music,
家人们给病人读故事 播放他们最爱的音乐
all in hopes of breaking through.
他们所做的一切都是为了将病人唤醒
Unfortunately, comas are medically complicated phenomenon
然而 昏迷是一种在医学上很复杂的现象
with different causes and effects.
它有着不同的原因和后果
And despite all our advances in modern medicine,
而且 尽管我们在现代医学上取得了许多进步
we remain mostly in the dark about how to successfully treat one.
在成功治愈昏迷上 我们仍几乎毫无进展
But what exactly happens to your body when you’re in a coma?
然而 在我们昏迷时 我们的身体究竟会有什么反应呢
First we have to be clear that comas are very different from sleep.
首先我们要明白 昏迷与睡觉完全不同
Despite the fact that the origin of the word comes from the greek for Koma, or deep sleep,
昏迷一词源于希腊语中的深度睡眠
comas are not sleep however and are instead various forms of unconsciousness
但昏迷并不是睡眠 而是不同形式的意识丧失
that render a person unable to respond to any external stimuli.
它们令人无法对外在的刺激作出反应
You can play the loudest, heaviest death metal in the world
在一个陷入昏迷的人身旁
right next to someone who’s comatose,
你甚至可以直接播放最吵闹的重金属音乐
and you won’t succeed in doing anything except really annoying the neighbors.
但这除了让邻居不堪其扰之外 不会有任何作用
Likewise you can even physically hurt people in a coma
同样的 你甚至可以对昏迷的人进行身体伤害
and they will remain completely oblivious and unresponsive.
但他们仍然毫无反应
In times not too distant past this was sometimes used as treating,
不久以前 这种方法有时还被用来治疗昏迷
with doctors trying to shock their victims back into consciousness.
医生会通过电击让病人清醒
Everything was tried
医生们尝试了无数种疗法
from exposing parts of the body to open flames
从用火焰烘烤病人的身体
to severely dropping the body’s temperature with ice,
到用冰块降低病人的身体温度
to even bloodletting from the head directly.
甚至直接从头部大放血
One treatment even included wholly emptying the stomach,
有一种疗法甚至要完全清空胃里的东西
we guess because the doctors thought that if a patient got hungry enough,
我们猜测医生认为如果病人足够饥饿
the body would force them to wake up.
他的身体就会强迫他醒来
Or maybe they really were just throwing everything including the kitchen sink at the problem,
或者这只是医生在尝试各种疗法而已
which we’re sure was also tried.
我们相信他们也实际运用过这种办法
Comas can occur as a result of serious trauma or as a deliberate medical treatment by doctors.
严重的外伤或医院的药物治疗会导致昏迷
They are typically brought on by traumatic head injury,
它们一般是由头部的外伤所致
and it’s believed that it’s the brain’s way of shutting down so it can focus on repairing itself.
因而昏迷也被认为是大脑进行自我修复的方法
They can also however be brought on by stroke, a brain tumor,
然而 昏迷也有可能由中风或脑瘤引起
drug or alcohol abuse, or an illness such as diabetes or an infection.
毒品 酗酒 糖尿病或感染等疾病也可能导致昏迷
Most of the time a coma only lasts a few weeks though,
多数情况下 昏迷只持续几周
but past this period
但在这段时间之后
the patient can enter a persistent vegetative state
病人会进入一种持续的植物人状态
that severely lessens their chances of ever coming back out of one.
而这严重降低了他们醒来的可能性
Sometimes people who recover may end up
有时从昏迷中清醒过来的人
with major or minor disabilities as well,
可能会有或大或小的机能缺失
to include speech impediments, mental retardation, or problem coordinating body movements.
比如交流困难 智力缺陷 或难以保持身体平衡
Medically induced comas meanwhile are used
与此同时 无论是物理伤害 毒品过度 还是疾病
when patients are at high risk of brain injury
当病人的大脑更有可能受到伤害时
either due to physical trauma, drug overdoses, or diseases.
医生会使用药物让病人昏迷
The purpose is to protect and control the pressure dynamics of the brain,
这样做的目的是保护与控制大脑的压迫
as during injury or disease
因为在人受伤或患病时
the brain can swell up and push against the skull
大脑会肿胀 并对头骨造成压力
which can starve some parts of the brain of oxygen.
导致大脑的一些组织缺氧
A medically induced coma reduces the electrical activity
药物导致的昏迷会减少大脑的电波
and slows down the brain’s metabolism,
并放缓它的生理代谢
minimizing swelling and inflammation.
以缓解肿胀和压迫
There are several different types of comas, and they each differ from each other.
昏迷有好几种类型 它们各不相同
A vegetative state means that a person’s body can make physical movements
植物人状态意味着一个人的身体可以做一些动作
such as grunts or yawns,
比如打呼噜或打哈欠
but has no reaction to actual stimuli.
但对外在刺激没有反应
The movements are purely involuntary,
这些动作完全是不自主的
and sadly for loved ones seeing the body of someone you care about
因此当病人突然打了一个哈欠
suddenly yawn can induce false hope.
病人家属看到后会有错误的希望
The truth is the brain remains shut down
而事实是 病人的大脑仍处于关闭状态
and operating only at the most basic levels.
并且只进行最基本的活动
Catatonia on the other hand is a complete lack of any movement or response of any kind.
紧张症则是病人完全没有任何动作或反应
This is exactly as it sounds,
没错 就是这么残酷
and often catatonic patients require help from machines to breathe
而且患有紧张症的病人经常需要使用呼吸机
and possibly even pump the heart.
甚至还需要通过人工按压使心脏跳动
Brain death means that the higher brain functions are completely destroyed,
脑死亡则意味着大脑的高级功能被完全摧毁
and the brain only carries out autonomic functions
只剩一些自主功能
such as breathing and swallowing which are hardwired into our brain’s programming.
比如呼吸和吞咽这种深深刻在大脑中的运动
A brain dead person has in effect no chance for recovery,
事实上 脑死亡的人几乎没有恢复的可能
and typically brain death results from extreme physical trauma or severe illness.
一般的脑死亡是由严重的身体伤害或疾病导致的
A stupor is technically not a form of a coma
昏呆实际上并不是昏迷
but is sometimes referred to as one.
但它经常被认为是其中一种
This is a case of one being able to be awakened,
在这种状态中 人们可以被唤醒
but only with considerable effort.
但只有在付出巨大努力之后才能达到
People in stupors can often fall right back into a deep unconsciousness,
在昏呆状态中的病人经常会进入深度无知觉状态
but more often than not will recover on their own.
但他们往往能自我恢复
The danger is if they dip so deep into unconsciousness,
但危险的是 如果病人长期处于无意识状态
that their autonomic functions are impaired.
他们大脑的自主功能就会损坏
While in a coma your brain shows zero awareness or cognitive processing,
在昏迷状态中 大脑没有意识 也不能处理信息
and is completely unable to respond to outside stimuli.
并且完全不能对外在刺激做出回应
It is in effect as if the brain has been completely turned off,
就好像大脑被完全关闭了
or is being rebooted like a computer.
或是像电脑一样被重启了
Except for in the most severe cases,
除了最严重的状态外
the body will continue to breathe
病人的身体会保持呼吸
and the heart will continue to pump,
心脏也会继续跳动
and if you block the airway patients can even cough
如果你把病人的呼吸道堵住 他甚至会咳嗽
as the body attempts to recover airflow.
这是因为他们的身体想要继续呼吸
But that’s about it,
但这就是全部了
as the brain seem to be unable to communicate through the brain stem and the cerebrum
因为大脑似乎难以与脑干
which controls cognitive consciousness
就是控制认知意识的部分
though a process called the reticular activating system.
通过一种网状激动系统连接上
Any doctor will admit
每一位医生都只能承认
that there’s a great deal we simply don’t know about the coma state.
关于昏迷 他们还有很多不知道的事情
And in 2013 doctors treating an epileptic man in a coma
2013年 在治疗一名昏迷的癫痫病人时
were puzzled to find brain activity in the hippocampus.
医生们惊讶地在病人的海马区发现了大脑活动
These ridges on the floor of each lateral ventricle of the brain
大脑每一个侧脑室上的隆起
are thought to be the center for emotion, memory, and the autonomic nervous system,
也就是情感 记忆 和自主神经系统的中心
meaning it’s quite possible that the unconscious person was experiencing memories but little else.
这表明这个昏迷的病人能且只能看到自己的记忆
The doctors replicated their findings in cats
医生们又重复了一次他们的实验
which were placed under general anesthetic,
这次是用全身麻醉的猫
and the knowledge they gleamed may help make some comas reversible.
从中得到的信息很可能会让一些昏迷的病人苏醒
While they don’t believe that
尽管医生们并不认为这意味着
this means a coma patient with this type of mental activity, or any other,
一个有许多心理活动的昏迷患者
has any sort of awareness or ability to communicate about their condition,
拥有交流自身情况的意识或能力
it is strong evidence for the fact that the brain does in fact take actions to
但对于大脑在昏迷状态中进行自我修复或保护
try and repair or protect itself while in a comatose state.
这的确是一个强有力的证据
The rest of the body typically remains unaffected by the coma state though,
与此同时 身体的其他部分并没有受到影响
with functions such as breathing and heart beating
比如呼吸和心跳
being so hardwired into our passive nervous system
这种深深刻在我们神经系统中的运动
that we do these things literally without thought.
我们基本上不用思考就能做出行动
People in a coma state though will require IV’s
处在昏迷中的人会接受静脉注射
through which they are fed and kept hydrated,
注入体内的物质会提供营养 保持水分
and are intubated with breathing tubes to maintain a clear airway,
并且用呼吸机进行插管治疗 保持呼吸道畅通
though some coma patients do retain the reflexes to swallow.
但有些病人仍会保持吞咽反射
The most common issue facing coma patients though is muscle atrophy,
然而 昏迷病人最常见的问题是肌肉萎缩
which comes from simply not using your muscles for prolonged periods of time.
这是长时间不使用肌肉导致的
You don’t need to be in a coma for this to happen though,
然而 不只是昏迷的病人有这种身体状况
if you’ve ever been a couch potato for a few weeks at a time,
如果你只是当了几周宅男
then you’ve likely experienced the severe weakness of muscles
那你就有可能会发现 由于缺少运动
that have atrophied from a lack of exercise.
你正在经历肌肉萎缩的痛苦
Even just getting up for a walk once a day can keep your muscles from wasting away.
只要每天站起来走走就会避免这种情况的发生
Bedsores are another serious concern for coma patients.
褥疮则是另一种需要对昏迷病人关注的问题
Also known as pressure ulcers,
它们也被称为压力溃疡
these are common for people who are bedridden or immobile,
这对于卧床不起的人和不爱运动的人很常见
or perhaps unable to sense pain.
它几乎不会让患者感到痛苦
These happen on areas of the skin that are
这种症状发生在
under pressure from lying in bed, sitting down,
长时间卧床或久坐
or wearing a tight cast for a very long time.
或者一直带着石膏的人的皮肤上
They develop when the blood supply to the skin is cut off for more than two to three hours,
当输送到皮肤的血液被切断超过2至3小时
and as the skin dies the bedsore starts
随着皮肤细胞的死亡 褥疮开始了
as a red, painful area which will eventually
起初皮肤会发红 疼痛
turn purple.
后来变成紫色
If not treated the skin will split open
如果不进行治疗 皮肤就会被撕裂
and the area runs the risk of infection.
这个部位就有被感染的风险
They can also become very deep if undetected or untreated,
如果不及时治疗
extending into the muscle or even the bone, and they’re very slow to heal.
它们会深入肌肉中 甚至骨头里 而且很难治好
Sometimes bedsore can take years to heal, and may require surgery.
有时候褥疮要好多年才能治好 并可能需要手术
The most common places bedsores form are on the buttocks area,
最常见的褥疮发生在屁股上
the heels of the feet, shoulder blades, back of the head,
脚后跟上 肩胛上 头部后面
and backs and sides of the knees.
以及后背和膝盖两侧
If left untreated they can grow grotesquely large.
如果不治疗 它们可能会变得非常大
if you have the stomach for it go ahead
如果你有胆量
and do a google image search for untreated bedsores,
你可以查一下未经治疗的图片
we did, and we deeply regret it.
我们这样做了 并且十分后悔
The good news about comas is
关于昏迷的好消息是
that despite what medical dramas may tell you,
无论关于医学的电视剧怎么演
most people recover within a few weeks
相比于病人之前的智力水平
to at least some level of their previous mental capacity.
多数人在几周后至少会在某种程度上有所恢复
However new research and techniques
然而 新的研究和技术
is continually improving our knowledge of comas
在持续提升我们关于昏迷的认识
and how to treat them.
以及治疗昏迷的方法
And in 2017 a 35 year old man who’d been in a vegetative state since he was 20
2017年 通过刺激一名35岁患者的迷走神经
was entered into a state doctors called “ minimal consciousness”
这个从20岁就处于植物人状态的昏迷病人
by stimulating the vagus nerve.
恢复到了医生称为“轻微清醒”的状态
This is one of the largest nerves in the body
迷走神经是人体内最大的神经系统之一
and goes directly to the heart lungs upper digestive tract and other organs.
并且直接联系心脏 肺部 消化道和其他器官
While not “ awake ”, doctors were able to have him follow objects with his eyes,
尽管他没有醒来 但医生能让他用眼睛追踪物体
and even prompted looks of surprise on his face,
甚至尝试让他做出惊讶的表情
though sadly he was unable to talk
但他还不能说话
or show any sort of higher brain function.
也不能使用任何一种更高级的大脑功能
Doctors warn though that while it’s a big step forward,
医生警告说 尽管这是个很大的进展
it’s far from a conclusive one
但这还远远不是结论
because comas are as radically different from each other as those who suffer them,
因为昏迷因人而异 并有很大差别
and what works on one individual may sadly not work on others.
因此并没有一种万金油式的疗法
How long would you give your family because asking them to just pull the plug on you?
你会让你的家人等待多久 再恢复清醒呢
if you liked this video,
如果你喜欢这个视频
check out what happens to your body when you fall into a volcano!
看看当你掉进火山的时候会发生什么
Oh, and how about clicking that like button?Bye bye.
记得给视频点赞哦 我们下期再见！