Kozlowski O, Pollez B, Thevenon A, Dhellemmes P, Rousseaux M
Service de rééducation et convalescence neurologiques, hôpital Swynghedauw, CHU, 59037 cedex, Lille, France.
Ann Readapt Med Phys. 2002 Nov;45(8):466-73. doi: 10.1016/s0168-6054(02)00297-0.
The late outcome of patients with severe traumatic brain injury (STBI) has been investigated by measuring deficits, disability and social handicap, but their quality of life (QOL) has been less evaluated, and not by a direct analysis of the subjective patient "and relatives" QOL. The aim of this study was to investigate this outcome and the QOL, with its predictive factors, 3 years after STBI, in a homogeneous cohort of patients.
We selected all adult patients from the Lille area (north of France) admitted in the CHU in 1995 following STBI. Each was evaluated at home, in the presence of a close relative, using the EBIS document. This one investigates the medical history, initial status and late outcome, as well as the subjective QOL of patients (evaluated by the patient and by a close relative: 0-10 on an analogical visual scale) and close relatives. Relationships between possible explanatory factors and QOL were analysed using correlation tests.
Among the 33 patients, 23 survived at three years. The mean initial GCS score was of 5,6/15 and the mean coma duration of 18.5 days. At three years, physical deficits were usually discrete, intellectual deficits more important and the emotional and behavioural problems even more severe. The GOS was of 6 in one patient, 4-5 in seven, 2-3 in seven and 0-1 in eight. Dependence in advanced activities was more sever than in elementary activities. The subjective QOL of patients was discretely lower (m = 5,48/10) than that estimated by close relatives (m = 5,91). The relatives QOL was similarly reduced (m = 5,45). The factors most influencing the patients QOL were the cognitive and behavioural problems and the dependence in the advanced activities and the GOS for the patients QOL, and the behavioural problem and the dependence in advanced activities for the relatives QOL.
The reduction of the patients "and relatives" QOL was parallel at three years. Emotional and behavioural problem as well as the dependence in advanced activities mainly explained these QOL.
通过测量缺陷、残疾和社会障碍来研究重度创伤性脑损伤（STBI）患者的远期预后，但对其生活质量（QOL）的评估较少，且未通过直接分析患者及其亲属的主观生活质量进行评估。本研究的目的是在一组同质化的患者中，调查STBI 3年后的这一预后情况及其生活质量，并分析其预测因素。
我们选取了1995年在法国北部里尔地区大学医院因STBI入院的所有成年患者。在一位近亲在场的情况下，使用EBIS文件对每位患者进行家访评估。该文件调查病史、初始状况和远期预后，以及患者（由患者和近亲评估：在类比视觉量表上为0至10分）和近亲的主观生活质量。使用相关性检验分析可能的解释因素与生活质量之间的关系。
33例患者中，23例在三年后存活。初始格拉斯哥昏迷量表（GCS）平均评分为5.6/15分，平均昏迷持续时间为18.5天。三年后，身体缺陷通常较轻，智力缺陷更为严重，情绪和行为问题甚至更严重。格拉斯哥预后评分（GOS）为6分的患者有1例，4 - 5分的有7例，2 - 3分的有7例，0 - 1分的有8例。在高级活动中的依赖程度比在基本活动中更严重。患者的主观生活质量（平均分为5.48/10分）略低于近亲估计值（平均分为5.91分）。亲属的生活质量同样降低（平均分为5.45分）。对患者生活质量影响最大的因素是认知和行为问题以及在高级活动中的依赖程度，对患者生活质量而言还有GOS；对亲属生活质量而言，影响因素是行为问题和在高级活动中的依赖程度。
患者及其亲属的生活质量在三年时均下降。情绪和行为问题以及在高级活动中的依赖程度是这些生活质量下降的主要原因。
