驾驶模拟可以提高对肝硬化患者驾驶技能受损的洞察力。
Driving simulation can improve insight into impaired driving skills in cirrhosis.
机构信息
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA.
出版信息
Dig Dis Sci. 2012 Feb;57(2):554-60. doi: 10.1007/s10620-011-1888-3. Epub 2011 Sep 8.
BACKGROUND
Minimal hepatic encephalopathy (MHE) is associated with poor driving skills and insight. Increasing insight may improve receptiveness for therapy or driving restrictions.
AIM
To evaluate the change in the self-assessment of driving skills (SADS) using a driving simulator.
METHODS
Cirrhotic patients and age/education-matched controls underwent MHE testing with inhibitory control (ICT) and the psychometric hepatic encephalopathy score (PHES). SADS, a Likert scale from 0 to 10, was administered just before and after a standardized driving simulation comprising testing and navigation tasks. The percentage SADS change from baseline was compared within/between groups.
RESULTS
A total of 84 patients (60% men, age 55 years) and 12 controls were included. Controls were significantly better than cirrhotics on cognitive/simulator testing. The baseline SADS was similar between the groups. The baseline patient SADS was only correlated with ICT lures (r = -0.4, P = 0.001). Post-simulation, 60% of patients improved their insight, i.e., reduced SADS (from 8 to 6.5, P = 0.0001) compared to 25% of controls (P = 0.02). The mean percentage SADS reduction was also higher in cirrhotics (18% vs. 8%, P = 0.03). MHE on ICT patients had a significantly higher SADS improvement (P = 0.004) compared to the other patients; no difference was seen in those with/without MHE due to the PHES. The percentage SADS reduction in patients was correlated with getting lost (r = 0.468, P < 0.0001), crashes (P = 0.002), and centerline/road-edge excursions (P = 0.01). There was a significantly higher percentage SADS reduction in cirrhotics who got lost (25%) compared to those who did not get lost (12%) and controls (8%, P = 0.014).
CONCLUSIONS
Insight into driving skills in cirrhosis improves after driving simulation and is highest in those with navigation errors and MHE on ICT. Driving simulator-associated insight improvement may be the first step towards the cognitive rehabilitation of driving skills in cirrhosis.
背景
轻微型肝性脑病（MHE）与较差的驾驶技能和洞察力有关。提高洞察力可能会提高对治疗或驾驶限制的接受程度。
目的
使用驾驶模拟器评估自我评估驾驶技能（SADS）的变化。
方法
对肝硬化患者和年龄/教育匹配的对照组进行 MHE 测试，包括抑制控制（ICT）和心理肝脏脑病评分（PHES）。使用从 0 到 10 的李克特量表，在标准化驾驶模拟测试和导航任务前后对 SADS 进行评估。从基线开始比较组内/组间的 SADS 变化百分比。
结果
共纳入 84 名患者（60%为男性，年龄 55 岁）和 12 名对照组。对照组在认知/模拟器测试方面明显优于肝硬化患者。组间基线 SADS 相似。基线时患者的 SADS 仅与 ICT 诱饵相关（r = -0.4，P = 0.001）。模拟后，60%的患者改善了洞察力，即 SADS 降低（从 8 降至 6.5，P = 0.0001），而对照组为 25%（P = 0.02）。肝硬化患者 SADS 降低的平均百分比也较高（18%比 8%，P = 0.03）。ICT 患者的 MHE 与 SADS 改善显著相关（P = 0.004），而 PHES 患者则无差异。患者 SADS 降低的百分比与迷路（r = 0.468，P < 0.0001）、撞车（P = 0.002）和中心线/道路边缘偏移（P = 0.01）相关。迷路的肝硬化患者 SADS 降低的百分比明显更高（25%），而不迷路的患者（12%）和对照组（8%）（P = 0.014）。
结论
肝硬化患者在驾驶模拟后对驾驶技能的洞察力提高，在有导航错误和 ICT 上的 MHE 的患者中提高最大。驾驶模拟器相关的洞察力改善可能是肝硬化患者认知康复驾驶技能的第一步。
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