认知运动分离在意识障碍中的研究现状及评估进展

doi:10.16138/j.1673-6087.2026.03.16

摘要/Abstract

摘要：

认知运动分离（cognitive motor dissociation，CMD）是脑损伤后意识障碍患者出现的特殊临床现象，指患者在床旁行为学评估中对指令无明确反应，但通过神经功能检测可观察到与指令相关的隐匿性意识活动，表现为意图性脑活动与外显运动行为之间的分离。与未检出CMD的无反应障碍患者相比，CMD患者在部分研究中显示出较高的意识恢复可能性和功能预后趋势，因此早期识别及评估具有重要意义。本文围绕CMD的概念、机制及主要评估技术进展进行综述，以期为意识障碍患者隐匿性意识的早期识别提供参考。

关键词: 意识障碍, 认知运动分离, 隐匿性意识, 功能磁共振成像

Abstract:

Cognitive motor dissociation (CMD) is a distinct clinical phenomenon in patients with disorders of consciousness after brain injury. It refers to the condition in which patients show no definite behavioral response to commands in bedside behavioral assessments, but command-related covert consciousness can be detected through neurofunctional testing, manifested as dissociation between task-related brain response and motor control. Compared with unresponsive patients without CMD, patients with CMD usually have a relatively favorable clinical prognosis, so early identification and assessment are of great significance. This article reviews the concept, mechanism and major advances in assessment techniques of CMD, so as to provide a reference for the early identification of covert consciousness in patients with disorders of consciousness.

Key words: disorders of consciousness, cognitive motor dissociation, covert consciousness, functional magnetic resonance imaging

中图分类号:

R741

达明莲, 牛彦霞, 李晓玲. 认知运动分离在意识障碍中的研究现状及评估进展[J]. 内科理论与实践, 2026, 21(03): 284-288.

DA Minglian, NIU Yanxia, LI Xiaoling. Current status and assessment progress of cognitive motor dissociation in disorders of consciousness[J]. Journal of Internal Medicine Concepts & Practice, 2026, 21(03): 284-288.

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参考文献 41

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评估手段	关键优势	临床应用价值	局限性
fMRI	分辨率高，可结合语言、音乐、运动想象等多种刺激范式	单独或联合EEG识别 CMD，辅助预后判断，为多模态评估重要工具	设备昂贵、操作复杂，不适用于不稳定患者
EEG	时间分辨率高，可床旁实施，有功率谱密度、任务相关电位等可量化指标	单独或联合fMRI，可耦合认知范式/BCI，为CMD评估的重要工具	空间定位精度有限，易受环境干扰
PET	可鉴别UWS与MCS，监测意识恢复过程中脑代谢动态变化	联合fMRI/EEG 提高CMD 检出敏感性，可独立预测预后	设备普及度低，不适用于急性期频繁检测
fNIRS	便携、无创，可床旁监测，适用于生命体征不稳定患者	动态捕捉大脑皮质血流动力学变化，识别急慢性DoC 患者隐匿性意识	空间分辨率低于 fMRI，探测深度有限
睡眠纺锤波	N2睡眠阶段的纺锤波类型，无需额外设备	WFSS阳性提示较好预后，可作为CMD早期预测信号	需专业EEG 分析，普适性待验证
自动瞳孔检测	可监测瞳孔扩张反应，低成本、便携、即时、无创	可作为新型生物标志物，与早期行为学评估互补	易受光线、药物、镇静影响