持续性植物状态患者生存状况及其影响因素分析  

Survival Situation in Patients with Persistent Vegetative State and Its Influencing Factors

作　　者：吴昆鹏[1] 陈莹[2] 言彩红[1] 黄治家[1] 桂培根[1] 吴正茂[1] 张群峰[1] 肖宏[1] 

机构地区：[1]南华大学附属第二医院重症医学科,湖南省衡阳市421001 [2]南华大学附属第二医院麻醉科,湖南省衡阳市421001

出　　处：《中国全科医学》2017年第5期558-562,共5页Chinese General Practice

摘　　要：目的探讨颅脑损伤后持续性植物状态(PVS)患者生存情况及预后相关因素。方法选取2009年1月—2014年6月在南华大学附属第二医院重症医学科入住的脑创伤及脑卒中的PVS患者196例,其中脑创伤108例,脑卒中88例。收集患者临床资料并对其进行随访,随访资料包括住院时间、营养方式、家庭经济情况、家庭照料情况、有无肺部感染、营养状况、生存状态等。分析患者的生存率,并采用Cox比例风险回归模型分析影响PVS患者预后的因素。结果 196例患者中位生存时间为12.5个月,1年生存率为53.5%,2年生存率为20.0%。不同性别、疾病类型者预后比较,差异无统计学意义(P>0.05);不同年龄、住院时间、有无胃造口、家庭经济情况、家庭照料情况、有无肺部感染、营养状况者预后比较,差异均有统计学意义(P<0.05)。多因素Cox比例风险回归模型分析结果显示,高龄、无胃造口、家庭照料情况差、有肺部感染、营养状况差是PVS患者预后不良的因素(P<0.05)。按照预后不良因素数量,将患者分为<2个预后不良因素者(n=109)和≥2个预后不良因素者(n=87),其中<2个预后不良因素者中位生存时间为18.9个月,1年生存率为80.5%,2年生存率为30.0%;≥2个预后不良因素者中位生存时间为7.8个月,1年生存率为14.8%,2年生存率为0。两者1年、2年生存率比较,差异均有统计学意义(χ~2=92.781,P<0.001;χ~2=26.073,P<0.001)。结论约50.0%PVS患者在1年内死亡。高龄、无胃造口、家庭照料情况差、有肺部感染、营养状况差是PVS患者预后的独立不良因素。Objective To investigate the survival situation in patients with persistent vegetative state （PVS） after brain trauma and to explore the factors associated with their prognosis. Methods From January 2009 to June 2014, we selected 196 patients with PVS （108 were due to brain trauma and 88 due to stroke） admitted to Department of Intensive Care Unit, the Second Hospital, University of South China as the subjects of this study. We collected the clinical data of the subjects and gave them a follow - up, the latter including the following ： length of hospital stay, alimentation mode, family economic conditions, family care status, incidence of lung infection, nutritional status, survival state and so on. The survival rate of patients was analyzed. And the factors influencing the prognosis of PVS patients were analyzed by Cox proportional hazards regression model. Results The median survival time was 12. 5 months, 1 - year overall survival rate was 53.5 % and 2 -year overall survival rate was 20. 0% for the 196 PVS patients. No difference in the prognosis was observed between PVS patients with different gender and type of disease （P 〉0. 05）. Age, length of hospital stay, stomach colostomy, family economic conditions, family care status, incidence of lung infection, nutritional status were the factors causing the statistically significant difference in the prognosis between the PVS patients （ P 〈 0. 05 ）. Resuits of Cox proportional hazards model analysis demonstrated that advanced age, no stomach colostomy, poor family care, lung infection and poor nutrition status were risk factors for the poor prognosis of PVS patients （ P 〈 0. 05 ）. According to the number of poor prognosis factors, the patients were divided into ： group with 0 or 1 poor prognosis factor （109 cases, the median survival time was 18.9 months; 1 -year, 2 -year survival rates were 80. 5%, 30. 0% , respectively） ; group with 2 or more poor prognosis factors （87 cases, the median survival time was 7.8 months; 1 - year,

关 键 词：持续植物人状态 预后 危险因素 

分 类 号：R741.04[医药卫生—神经病学与精神病学]