■关于长期意识障碍(PDOC)的预后的发现在不同的研究中差异很大。这项研究旨在调查死亡率,PDOC脑损伤后患者的意识恢复和残疾。
■共有204例PDOC患者被纳入一项纵向队列研究,包括129名男性和75名女性。创伤性脑损伤(TBI)112例,62例脑出血(CH),脑梗塞(CI)13例,缺血性缺氧脑病(IHE)17例。使用修订的昏迷恢复量表(CRS-R)评估或随访病程的1、2、3、6、12、18、24、36、48个月的意识状态。如果病人是清醒的,还进行了残疾评定量表(DRS).不同PDOC包括昏迷的预后,分析了植物状态(VS)和最低意识状态(MCS)。对存活患者进行变量筛选,纳入多因素二元Logistic回归筛选影响意识恢复的因素。
■12、24、36和48个月的死亡率分别为10.7、23.4、38.9和68.4%,分别。中位死亡时间为18个月(8.75,29)。MCS恢复意识的概率高于VS(p<0.05),患者的残疾程度低于VS(p<0.05)。MCS-组和MCS+组恢复意识的概率无显著差异,剩余残疾的程度,和死亡率(p>0.05)。昏迷的死亡率高于其他PDOC(p<0.05)。MCS的死亡率低于VS,但差异无统计学意义(p>0.05)。TBI后意识恢复的概率最高,死亡率最低。IHE意识恢复的可能性最小,CI的死亡率最高。脑损伤原因和初始CRS-R评分是影响患者意识恢复的因素(p<0.05)。
■MCS的预后比VS更好,MCS-和MCS+之间具有可比性的结果,而昏迷患者是最贫穷的。TBI预后最好,IHE预后最差。
UNASSIGNED: The findings regarding the prognosis of prolonged disorders of consciousness (PDOC) vary widely among different studies. This study aims to investigate the mortality, consciousness recovery and disabilities of patients with PDOC after brain injury.
UNASSIGNED: A total of 204 patients with PDOC were included in a longitudinal cohort study, including 129 males and 75 females. There were 112 cases of traumatic brain injury (TBI), 62 cases of cerebral hemorrhage (CH), 13 cases of cerebral infarction (CI) and 17 cases of ischemic hypoxic encephalopathy (IHE). The status of consciousness at 1, 2, 3, 6, 12, 18, 24, 36, 48 months of the disease course was assessed or followed up using the Revised Coma Recovery Scale (CRS-R). If the patients were conscious, the disability Rating Scale (DRS) was also performed. The prognosis of different PDOC including coma, vegetative state (VS) and minimal conscious state (MCS) was analyzed. The survival patients were screened for variables and included in multivariate binary Logistic regression to screen the factors affecting the recovery of consciousness.
UNASSIGNED: The mortality rates at 12, 24, 36, and 48 months were 10.7, 23.4, 38.9, and 68.4%, respectively. The median time of death was 18 months (8.75, 29). The probability of MCS regaining consciousness was higher than VS (p < 0.05), with the degree of disability left lower than VS (p < 0.05). There was no significant difference between MCS- and MCS+ groups in terms of the probability of regaining consciousness, the extent of residual disability, and mortality rates (p > 0.05). The mortality rate of coma was higher than that of other PDOC (p < 0.05). The mortality rate of MCS was lower than that of VS, but the difference was not statistically significant (p > 0.05). The probability of consciousness recovery after TBI was the highest and the mortality rate was the lowest. The possibility of consciousness recovery in IHE was the least, and the mortality rate of CI was the highest. The cause of brain injury and initial CRS-R score were the factors affecting the consciousness recovery of patients (p < 0.05).
UNASSIGNED: The prognosis of MCS is more favorable than VS, with comparable outcomes between MCS- and MCS+, while comatose patients was the poorest. TBI has the best prognosis and IHE has the worst prognosis.