脑干出血患者基本生命体征与意识障碍行为学评分的相关性分析  

Correlation analysis of basic vital signs and behavioral score of disorders of consciousness in patients with brainstem hemorrhage

作　　者：左诗怡 孙娟 陈珍珍 蔡涵旭 胡志安[2] 姚忠祥[2] 刘勇 ZUO Shiyi;SUN Juan;CHEN Zhenzhen;CAI Hanxu;HU Zhi'an;YAO Zhongxiang;LIU Yong(Department of Pain and Rehabilitation,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037;Department of Physiology,Institute of Brain and Intelligence,College of Basic Medical Sciences,Army Medical University(Third Military Medical University),Chongqing,400038,China)

机构地区：[1]陆军军医大学(第三军医大学)第二附属医院疼痛与康复医学科,重庆400037 [2]陆军军医大学(第三军医大学)基础医学院生理学教研室,脑与智能研究院,重庆400038

出　　处：《第三军医大学学报》2021年第15期1418-1423,共6页Journal of Third Military Medical University

基　　金：国家自然科学基金创新研究群体项目(31921003)。

摘　　要：目的研究脑干出血患者基本生命体征与意识障碍行为学评分的相关性。方法从陆军军医大学第二附属医院神经外科2015年1月至2020年11月收治的375例脑干出血患者中筛选出73例,依据入院后24 h内的格拉斯哥昏迷量表(Glasgow Coma Scale, GCS)评分将其分为无意识障碍组(n=38)和重度意识障碍组(n=35),比较入院后24 h内、出院前24 h内两个时期的GCS评分及GCS中应答能力、行为认知能力、肢体对疼痛刺激反应、自行睁眼反应等行为学表现,以及腋测体温、脉搏频率和呼吸频率变化情况。根据是否有前述的行为学表现,又将重度意识障碍组患者分为有行为表现组(n=21)与无行为表现组(n=14),比较二者的腋测体温、脉搏频率和呼吸频率变化。将无意识障碍组、重度意识障碍组入院后24 h内、出院前24 h内的GCS评分与同时期的腋测体温、脉搏频率和呼吸频率进行相关性和差异性分析。结果在入院后24 h内、出院前24 h内两个时期,与无意识障碍组相比,重度意识障碍组患者的GCS评分更低,腋测体温和脉搏频率频率均显著升高(P<0.05);但入院后24 h内的呼吸频率两组间差异无统计学意义,而出院前24 h内呼吸频率则在重度意识障碍组患者显著升高(P<0.05)。另外,无意识障碍组、重度意识障碍组两个时期的GCS评分与同时期的腋测体温、脉搏频率和呼吸频率差异均无统计学意义。重度意识障碍患者有行为表现组与无行为表现组在两个时期的腋测体温、呼吸频率、入院后24 h内脉搏频率差异均无统计学意义,但无行为表现组出院前24 h内的脉搏频率较有行为表现组明显升高(P<0.05)。结论脑干出血患者基本生命体征与意识障碍行为学评分紧密相关,其中入院后24 h内和出院前24 h内的腋测体温、脉搏频率的升高与意识障碍患者GCS评分降低呈显著正相关。Objective To study the correlation of basic vital signs with behavioral score of disorders of consciousness(DOC)in patients with brainstem hemorrhage.Methods A total of 73 patients with brain stem hemorrhage were screened out from 375 patients admitted to the Department of Neurosurgery of the Second Affiliated Hospital of Army Medical University from January 2015 to November 2020.According to the Glasgow Coma Scale(GCS)score within 24 h after admission,they were divided into normal consciousness group(n=38)and severe DOC group(n=35).Their GCS score,GCS response ability,behavioral cognitive ability,limb response to pain stimulation and eye-opening response,as well as axillary temperature,pulse rate and respiratory rate were compared between the 2 groups at the 2 time points,that is,24 h after admission and 24 h before discharge.According to the behavioral responses mentioned above,the patients out of severe DOC group were further assigned into the subgroup having behavioral responses(behavioral subgroup,n=21)and the subgroup without(non-behavioral subgroup,n=14),and the changes of axillary temperature,pulse rate and respiratory rate were compared with between them.The correlations and differences among the GCS scores and axillary body temperature,pulse rate and respiratory rate were analyzed between the normal consciousness group and the severe DOC group during the 24 h after admission and 24 h before discharge.Results In 24 h after admission and 24 h before discharge,the patients in the severe DOC group had significantly lower GCS scores and higher mean temperature and pulse rate than the normal consciousness group(P<0.05).However,there was no statistical difference in the mean respiratory rate within 24 h after admission between the 2 groups(P>0.05),and the rate within 24 h before discharge was obviously higher in the severe DOC group than another group(P<0.05).In addition,no statistical correlations were observed among GCS scores and axillary temperature,pulse rate and respiratory rate in the 2 groups at the 2

关 键 词：脑干出血 基本生命体征 意识障碍 行为学评分 相关性 

分 类 号：R741.04[医药卫生—神经病学与精神病学] R743.34[医药卫生—临床医学]