弥漫性轴索损伤致慢性意识障碍患者意识恢复的影响因素分析  

Influencing factors of consciousness recovery in patients with chronic disorders of consciousness caused by diffuse axonal injury

作　　者：杨艺 党圆圆 徐珑[2] 夏小雨 陈雪玲 王勇[3] 刘伟明[2] 何江弘 Yang Yi;Dang Yuanyuan;Xu long;Xia Xiaoyu;Chen Xueling;Wang Yong;Liu Weiming;He Jianghong(Department of Neurosurgery,the 7th Medical Center of PLA General Hospital,Beijing 100700,China;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Institute of Electrical Engineering,Yanshan University,Qinhuangdao 066004,China)

机构地区：[1]解放军总医院第七医学中心神经外科,北京100700 [2]首都医科大学附属北京天坛医院神经外科,100070 [3]燕山大学电气工程学院,秦皇岛066004

出　　处：《中华神经外科杂志》2020年第10期998-1003,共6页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81600919);北京市科技新星计划(Z181100006218050)。

摘　　要：目的探讨影响弥漫性轴索损伤(DAI)导致慢性意识障碍(DOC)患者意识恢复的因素。方法回顾性分析2014年1月至2019年12月解放军总医院第七医学中心神经外科收治的51例DAI致DOC患者的临床资料。根据患者的意识恢复情况(格拉斯哥预后评级Ⅱ级以上为意识恢复),分为意识恢复组(29例)和意识未恢复组(22例)。采用单因素分析方法探讨DAI导致慢性DOC患者意识恢复的可能影响因素,包括患者的年龄、性别、致伤原因、病程、入院昏迷恢复量表-修订版(CRS-R)评分、意识水平(微意识状态或植物状态)、重症监护病房(ICU)停留时间、呼吸机使用时长、DAI病变数量和损伤等级、DAI关键部位的弥散张量成像部分各向异性(FA)值以及术后并发症(包括脑积水、癫痫、感染、阵发性交感神经过度兴奋综合征)。采用多因素logistic回归分析方法明确DOC患者意识恢复的独立影响因素。结果单因素分析结果表明,患者的发病年龄、微意识状态患者所占比例、入院CRS-R评分、术后合并脑积水、影像学DAI损伤等级、DAI关键部位的FA值可能为患者意识恢复的影响因素(均P<0.05)。多因素logistic回归分析结果表明,年龄(OR=1.316,95%CI:1.078~1.580,P=0.006)、入院CRS-R评分(OR=0.200,95%CI:0.044~0.910,P=0.037)、脑干白质损伤(OR=3.991,95%CI:0~21.261,P=0.040)以及术后脑积水(OR=11.874,95%CI:0.308~76.078,P=0.045)是DAI导致DOC患者意识恢复的独立影响因素。结论对于DAI导致慢性DOC患者,术后合并脑积水、年龄偏高、DAI关键部位的损伤严重、入院CRS-R评分低均不利于其意识恢复。Objective To analyze the influencing factors of consciousness recovery in patients with chronic disorders of consciousness(DOC)caused by diffuse axonal injury(DAI).Methods A total of 51 DAI-induced DOC patients admitted to Department of Neurosurgery,the 7th Medical Center of PLA General Hospital from January 2014 to December 2019 were retrospectively reviewed in this study.According to the state of consciousness,all patients were divided into recovered group(29 cases)and non-recovered group(22 cases).Univariate analysis method was used to explore the possible factors that might affect the recovery of consciousness in patients with chronic DOC,including the patient′s age,sex,cause of injury,course of illness,preoperative coma recovery scale-revised(CRS-R)score,level of consciousness(minimally conscious state or vegetative state),length of stay in the intensive care unit(ICU),length of use of the ventilator,number of DAI lesions and injury degrees,diffusion tensor imaging(DTI)fractional anisotropy(FA)value of DAI key sites,and postoperative complications(including hydrocephalus,epilepsy,infection,and paroxysmal sympathetic overactivity syndrome).The independent influencing factors of DOC patient′s consciousness recovery were identified by multivariate logistic regression analysis.Results The results of univariate analysis showed that the age of onset,proportion of patients with minimally consciousness state,preoperative CRS-R score,postoperative combined hydrocephalus,DAI degree on imaging,FA value of key sites of DAI may be the influencing factors of patient′s consciousness recovery(all P<0.05).The results of multivariate logistic regression analysis showed that age(OR=1.316,95%CI:1.078-1.580,P=0.006),preoperative CRS-R score(OR=0.200,95%CI:0.044-0.910,P=0.037),brainstem white matter damage(OR=3.991,95%CI:0-21.261,P=0.040),and postoperative hydrocephalus(OR=11.874,95%CI:0.308-76.078,P=0.045)were independent influencing factors in the recovery of consciousness in DOC patients.Conclusion In DAI-induced DOC pat

关 键 词：意识障碍 弥漫性轴索损伤 疾病特征 预后 危险因素 

分 类 号：R651.15[医药卫生—外科学]