Klein Anke-Maria, Howell Kaitlen, Straube Andreas, Pfefferkorn Thomas, Bender Andreas
Department of Neurology, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany; Department of Physical Medicine and Rehabilitation, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany.
Clin Neurol Neurosurg. 2013 Oct;115(10):2136-41. doi: 10.1016/j.clineuro.2013.08.004. Epub 2013 Aug 12.
Our objectives were to evaluate rehabilitation outcome of aSAH survivors with severe disorders of consciousness (DOC) and to examine potential predictors of long-term outcome. Severe DOC includes patients in a vegetative state (VS) and in a minimally conscious state (MCS).
This is a retrospective single-center cohort study of consecutive aSAH patients with severe and prolonged DOC upon admission to neurorehabilitation. Clinical assessments started right after discharge from ICU, a median of 26 days after the aSAH. Two different outcome criteria were used, one addressing the functional aspect (assessed by the Functional Independence Measure [FIM]) the other one addressing the level of consciousness ("behavioral outcome", assessed by the Coma Remission Scale [CRS]). Improved outcome was defined by an increase in FIM scores of at least 22 points (minimal clinically important difference) or by reaching a full score of 24 points on the CRS. Separate least square linear regression models were calculated to examine potential predictors for functional and behavioral outcome.
Out of 63 patients, 19.0% and 39.7% of the patients achieved an improved functional and behavioral outcome, respectively. Age and level of consciousness upon admission to neurorehabilitation were independent prognostic factors for both outcome definitions. Both groups reached the better outcome category after a median of 11 and 9 weeks, respectively. In an individual patient, the longest delay to achievement of improved functional outcome was 30 weeks and to favorable behavioral outcome was 22 weeks after rehabilitation admission.
About one-third of severely affected aSAH patients with DOC regained at least a favorable behavioral status during early neurorehabilitation. It is interesting to note that in our study population, the beginning of clinical improvement took up to 6 months after aSAH.
我们的目的是评估伴有严重意识障碍（DOC）的急性蛛网膜下腔出血（aSAH）幸存者的康复结局，并研究长期结局的潜在预测因素。严重DOC包括植物状态（VS）和最低意识状态（MCS）的患者。
这是一项回顾性单中心队列研究，研究对象为连续入住神经康复科时伴有严重且持续DOC的aSAH患者。临床评估在患者从重症监护病房（ICU）出院后立即开始，中位时间为aSAH后26天。使用了两种不同的结局标准，一种针对功能方面（通过功能独立性测量[FIM]进行评估），另一种针对意识水平（“行为结局”，通过昏迷恢复量表[CRS]进行评估）。结局改善定义为FIM评分至少增加22分（最小临床重要差异）或CRS达到满分24分。计算单独的最小二乘线性回归模型，以研究功能和行为结局的潜在预测因素。
63例患者中，分别有19.0%和39.7%的患者实现了功能和行为结局的改善。入住神经康复科时的年龄和意识水平是两种结局定义的独立预后因素。两组分别在中位时间11周和9周后达到较好的结局类别。在个体患者中，康复入院后实现功能结局改善的最长延迟时间为30周，实现良好行为结局的最长延迟时间为22周。
约三分之一伴有严重DOC的aSAH患者在早期神经康复期间至少恢复了良好的行为状态。值得注意的是，在我们的研究人群中，临床改善始于aSAH后长达6个月。
