酒精对颅脑损伤患者早期格拉斯哥昏迷量表的影响。
Influence of alcohol on early Glasgow Coma Scale in head-injured patients.
作者信息
Shahin Hazem, Gopinath Shankar P, Robertson Claudia S
机构信息
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas 77030, USA.
出版信息
J Trauma. 2010 Nov;69(5):1176-81; discussion 1181. doi: 10.1097/TA.0b013e3181edbd47.
BACKGROUND
To assess the depressant effects of alcohol on the level of consciousness of patients admitted with head injuries, this study examined the changes that occur in the Glasgow Coma Scale (GCS) of traumatic brain injury patients over time.
METHODS
The records of 269 head trauma patients consecutively admitted to the neurosurgery intensive care unit were examined retrospectively. Eighty-one patients were excluded because of incomplete data. The remaining 188 patients were further divided into an intoxicated group (blood alcohol concentration [BAC] ≥ 0.08%, n = 100 [53%]) and a nonintoxicated group (BAC <0.08%, n = 88 [47%]). The GCS in the prehospital setting, in the emergency department, and the highest GCS achieved during the first 24 hours postinjury were compared.
RESULTS
The change between emergency department-GCS and the best day 1 GCS in the intoxicated group was greater than the nonintoxicated group and deemed clinically and statistically significant; median change (3 vs. 0) p < 0.001. To assess whether these results were directly related to the BAC%, piecewise regression using a general linear model was used to assess the intercept and slope of alcohol on the changes of GCS with cutting point at BAC% = 0.08. The analysis showed that, in the nonintoxicated range, the effect of alcohol was not significantly related to the changes of GCS. But in the intoxicated range, BAC% was significantly positively related to the changes of GCS.
CONCLUSION
This study concludes that the GCS increases significantly over time in alcohol intoxicated patients with traumatic brain injury.
背景
为评估酒精对头部受伤患者意识水平的抑制作用，本研究调查了创伤性脑损伤患者格拉斯哥昏迷量表（GCS）随时间的变化情况。
方法
对神经外科重症监护病房连续收治的269例头部创伤患者的记录进行回顾性研究。81例患者因数据不完整被排除。其余188例患者进一步分为醉酒组（血液酒精浓度[BAC]≥0.08%，n = 100[53%]）和未醉酒组（BAC < 0.08%，n = 88[47%]）。比较了院前、急诊科的GCS以及伤后24小时内达到的最高GCS。
结果
醉酒组急诊科GCS与伤后第1天最佳GCS之间的变化大于未醉酒组，且在临床和统计学上具有显著意义；中位数变化（3对0）p < 0.001。为评估这些结果是否与BAC%直接相关，使用一般线性模型进行分段回归，以评估酒精在BAC% = 0.08处对GCS变化的截距和斜率。分析表明，在未醉酒范围内，酒精的作用与GCS变化无显著相关性。但在醉酒范围内，BAC%与GCS变化显著正相关。
结论
本研究得出结论，创伤性脑损伤的酒精中毒患者的GCS随时间显著增加。
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