应用临床意识量表评估意识障碍程度的敏感性  

The preliminary study of the sensitivity of clinical consciousness scales to patients with disorders of consciousness

作　　者：余丹[1,2] 高坚[2] 李景琦[2] 狄海波[1] 

机构地区：[1]杭州师范大学国际植物状态和意识科学研究所,杭州310036 [2]武警浙江总队杭州医院康复中心

出　　处：《中华急诊医学杂志》2012年第4期406-410,共5页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金（30870861）;浙江省科技厅中外合作重大项目（2008C14098）

摘　　要：目的应用3种临床意识量表评估意识障碍程度，比较各量表问敏感性，为其临床使用提供更好的依据。方法对武警浙江总队杭州医院康复中心84例植物状态（Vs）患者进行前瞻性研究。应用格拉斯哥昏迷量表（GCS）、改进的昏迷恢复量表（CRS—R）、中国植物状态量表（cvss）对患者进行评分，以6个月或患者脱离最小意识状态（MCS）为评分止点，进行每2周（12周内）或4周（12～24周）1次的跟踪检测，观察患者由Vs转换为MCS时各量表的敏感性及CRS—R量表中各子量表的敏感性；同时观察被CRS—R量表一直诊断为Vs的患者，与其他量表诊断的一致性；并对患者入院时（36例急性期及48例慢性期）各量表总分行Spearman相关系数分析。结果84例Vs患者共有47例转变为MCS，在所有量表中，CRS—R量表对诊断MCS最敏感（P〈0．05），CRS—R子量表中又以视觉子量表最敏感（P〈0．01）。对其余37例患者，3个量表均诊断为Vs。各量表总分相关性分析显示CRS—R量表与GCS量表在急性期及慢性期的相关性具有统计学意义（P〈0．01），与CVSS仅在急性期有一定相关性（P〈0．05）。结论在意识障碍恢复过程中，CRS—R量表是判断MCS的较敏感量表，在CRS—R子量表中又以视觉子量表判断MCS较敏感；但对意识障碍程度严重且没有明显恢复的患者，3个量表判断意识障碍程度一致性较好；CRS—R量表可广泛应用于意识障碍评估的各阶段。Objective To evaluate the sensitivity of three different clinical consciousness scales to patients with disorders of consciousness. Methods A total of 84 patients in vegetative state （VS） were selected and scored by the consciousness scales including Glasgow Coma Scale （GCS） , Coma Recovery Scale-Revised （CRS-R） and Chinese Vegetative State Scale （CVSS） respectively. The patients were followed every 2 weeks for 12 weeks or every 4 weeks for 12-24 weeks. The assessment finished in 6 months or till the time when patients emerged from minimally conscious state （ MCS. The diagnostic sensitivity and the sensitivities of each sub-scale in CRS-R were evaluated when the patients with MCS emerged from VS. The diagnostic consistency with other scales was observed and analyzed by Spearman correlation as well. The Spearman -relate was used to analyze the correlations among the total scores of three scales in the patients on admission （36 patients with acute and 48 patients with chronic phase）. Results Of 84 VS patients, there were 47 emerged to MCS . CRS-R was the most sensitive in the diagnosis of MCS （P 〈 0. 05 ） among all scales. The visual subseale is the most sensitive among all the CRS-R subscales （P 〈0.01 ）. Among the 84 patients, the remaining 37 were diagnosed as VS by all three scales. The total scores correlation analysis showed that the score of CRS-Pt significantly con＇elate with that of GCS in acute and chronic phase （ P 〈 0. 01 ） and significantly correlate with that of CVSS only in the acute stage （ P 〈 0. 05）. Conclusions It is indicated that CRS-R, especially the visual subscale of CRS-R is the more sensitive tool for detecting. MCS during recovery process in the disorders of consciousness. As to the patients with deep unconsciousness and with no significant recovery, the three instruments are in good agreement to determine the degree of disorders of consciousness. It is suggested that CRS-R can be widely used to assess the level of consciousness in various st

关 键 词：植物状态 最小意识状态 意识量表 

分 类 号：R749.1[医药卫生—神经病学与精神病学]