CRS-R对4岁及以上意识障碍患儿意识恢复的预测价值研究  

Prognostic value of coma recovery scale-revised in children≥4 years old with disorder of consciousness

作　　者：冯英[1] 段晓玲[1] 江伟[1] 陈玉霞[1] 刘玲[1] 肖农[1] FENG Ying;DUAN Xiaoling;JIANG Wei;CHEN Yuxia;LIU Ling;XIAO Nong(Department of Rehabilitation,Children′s Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders/China International Science and Technology Cooperation base of Child development and Critical Disorders/Developmental Diseases Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院康复科/儿童发育疾病研究教育部重点实验室/国家儿童健康与疾病临床医学研究中心/儿童发育重大疾病国家国际科技合作基地/儿科学重庆市重点实验室,重庆400014

出　　处：《现代医药卫生》2021年第16期2717-2721,共5页Journal of Modern Medicine & Health

基　　金：重庆科卫联合医学科研项目(2021MSXM229)。

摘　　要：目的探讨改良昏迷恢复评估量表(CRS-R)对4岁及以上意识障碍(DOC)患儿意识恢复的预测价值。方法分析2013年8月至2017年7月入住该院康复科的创伤性和非创伤性病因导致的4岁及以上恢复期DOC患儿的临床资料,记录性别、年龄、病因、首次CRS-R评分、意识恢复时间等。结果共纳入99例患儿(创伤性脑损伤30例,非创伤性脑损伤69例),随访至病程2年,创伤性、非创伤性脑损伤患儿意识恢复率分别为83.3%(25/30)、65.2%(45/69),两组比较,差异无统计学意义(P>0.05)。无论是创伤性还是非创伤性,意识恢复组患儿入科时CRS-R评分分别为(9.52±2.68)、(8.02±2.66)分,均比意识未恢复组[分别为(4.80±2.86)、(5.63±2.39)分)]高,差异均有统计学意义(P<0.05)。创伤性脑损伤患儿CRS-R预测意识恢复受试者工作特征曲线(ROC曲线)下面积(A)=0.892[95%可信区间(95%CI)0.69~1.00],CRS-R评分大于或等于6分时对意识恢复预测的灵敏度为100.0%,特异度为80.0%。非创伤性脑损伤患儿CRS-R预测意识恢复ROC曲线下A=0.819(95%CI 0.695~0.942),CRS-R评分大于或等于6分时对意识恢复预测的灵敏度为97.8%,特异度为71.0%。结论对于4岁及以上的恢复期DOC患儿,无论是创伤性还是非创伤性,CRS-R均可作为其发病2年时意识能否恢复的预测指标,入科时CRS-R评分大于或等于6分患儿其病程2年时意识恢复的可能性更大。Objective To explore the prognostic value of coma recovery scale-revised(CRS-R)in children≥4 years old with disorder of consciousness(DOC).Methods The clinical data of children≥4 years with DOC during the recovery period caused by traumatic and non-traumatic causes who were admitted to the rehabilitation department of the hospital from August 2013 to July 2017 were analyzed,and the gender,age,etiology,the first CRS-R scores,recovery time of consciousness etc of them were recorded.Results A total of 99 children(30 cases of traumatic brain injury and 69 cases of non-traumatic brain injury)were enrolled and followed up to 2 years.The recovery rate of consciousness of children with traumatic brain injury and non-traumatic brain injury was 83.3%(25/30),65.2%(45/69)respectively,there was no statistically significant difference between the two groups(P>0.05).Regardless of traumatic or non-traumatic causes,the CRS-R scores of the children in the consciousness recovery group were(9.52±2.68)scores and(8.02±2.66)scores respectively at the time of admission,which were higher than those in the unrecovered consciousness group[respectively(4.80±2.86),(5.63±2.39)scores],the differences were statistically significant(P<0.05).The area(A)under the receiver operating characteristic curve(ROC curve)of CRS-R predicts recovery of consciousness in children with traumatic brain injury was 0.892[95%confidence interval(95%CI 0.69-1.00)].When CRS-R score was greater than or equal to 6 scores,the sensitivity for predicting recovery of consciousness was 100.0%,and the specificity was 80.0%.The A under the ROC curve of CRS-R predicting recovery of consciousness in children with non-traumatic brain injury was 0.819(95%CI 0.695-0.942),when the CRS-R score was greater than or equal to 6 scores,the sensitivity of predicting recovery of consciousness was 97.8%,and the specificity was 71.0%.Conclusion For children≥4 years with DOC during the recovery period,whether it is caused by traumatic or non-traumatic etiology,CRS-R can be used as a

关 键 词：改良昏迷恢复评估量表 意识障碍 儿童 预测价值 

分 类 号：R49[医药卫生—康复医学]