James A. Haley Veterans Hospital, Tampa, Florida 33612, USA.
J Neurotrauma. 2012 Jan 1;29(1):59-65. doi: 10.1089/neu.2011.1829. Epub 2011 Aug 4.
Few studies address the course of recovery from prolonged disorders of consciousness (DOC) after severe traumatic brain injury (TBI). This study examined acute and long-term outcomes of persons with DOC admitted to acute inpatient rehabilitation within the National Institute on Disability and Rehabilitation Research (NIDRR) TBI Model Systems Programs (TBIMS). Of 9028 persons enrolled from 1988 to 2009, 396 from 20 centers met study criteria. Participants were primarily male (73%), Caucasian (67%), injured in motor vehicle collision (66%), with a median age of 28, and emergency department Glasgow Coma Scale (GCS) score of 3. Participant status was evaluated at acute rehabilitation admission and discharge and at 1, 2, and 5 years post-injury. During inpatient rehabilitation, 268 of 396 (68%) regained consciousness and 91 (23%) emerged from post-traumatic amnesia (PTA). Participants demonstrated significant improvements on GCS (z=16.135, p≤0.001) and Functional Independence Measure (FIM) (z=15.584, p≤0.001) from rehabilitation admission (median GCS=9; FIM=18) to discharge (median GCS=14; FIM=43). Of 337 with at least one follow-up visit, 28 (8%) had died by 2.1 years (mean) after discharge. Among survivors, 66 (21%) improved to become capable of living without in-house supervision, and 63 demonstrated employment potential using the Disability Rating Scale (DRS). Participants with follow-up data at 1, 2, and 5 years post-injury (n=108) demonstrated significant improvement across all follow-up evaluations on the FIM Cognitive and Supervision Rating Scale (p<0.01). Significant improvements were observed on the DRS and FIM Motor at 1 and 2 years post-injury (p<0.01). Persons with DOC at the time of admission to inpatient rehabilitation showed functional improvement throughout early recovery and in years post-injury.
很少有研究探讨严重创伤性脑损伤（TBI）后长时间意识障碍（DOC）的恢复过程。本研究检查了在国家残疾和康复研究研究所（NIDRR）TBI 模型系统计划（TBIMS）急性住院康复机构中收治的 DOC 患者的急性和长期结局。1988 年至 2009 年间共纳入 9028 人，来自 20 个中心的 396 人符合研究标准。参与者主要为男性（73%）、白种人（67%）、车祸受伤（66%），中位年龄为 28 岁，急诊室格拉斯哥昏迷量表（GCS）评分为 3 分。参与者状态在急性康复入院和出院时以及受伤后 1、2 和 5 年进行评估。在住院康复期间，396 名患者中有 268 名（68%）恢复意识，91 名（23%）从创伤后遗忘症（PTA）中恢复。参与者的 GCS（z=16.135，p≤0.001）和功能独立性测量（FIM）（z=15.584，p≤0.001）在康复入院（GCS 中位数=9；FIM=18）和出院（GCS 中位数=14；FIM=43）时均有显著改善。在至少有一次随访的 337 名参与者中，28 名（8%）在出院后 2.1 年（平均）时死亡。在幸存者中，有 66 名（21%）改善到能够在没有家庭监督的情况下生活，有 63 名使用残疾评定量表（DRS）表现出就业潜力。在受伤后 1、2 和 5 年有随访数据的参与者（n=108）在 FIM 认知和监督评定量表的所有随访评估中均表现出显著改善（p<0.01）。在受伤后 1 和 2 年时，DRS 和 FIM 运动方面也观察到显著改善（p<0.01）。在住院康复入院时患有 DOC 的患者在早期恢复和受伤后多年都表现出功能改善。
