在一项基于人群的创伤性脑损伤成年患者前瞻性研究中意识障碍的发生率
Rate of disorders of consciousness in a prospective population-based study of adults with traumatic brain injury.
作者信息
Løvstad Marianne, Andelic Nada, Knoph Rein, Jerstad Tone, Anke Audny, Skandsen Toril, Hauger Solveig L, Giacino Joseph T, Røe Cecilie, Schanke Anne-Kristine
机构信息
Research Department, Sunnaas Rehabilitation Hospital, Nesodden, Norway (Drs Løvstad and Schanke and Ms Hauger); Department of Psychology, University of Oslo, Oslo, Norway (Drs Løvstad and Schanke); Departments of Physical Medicine and Rehabilitation (Drs Andelic and Røe) and Radiology (Dr Jerstad), Oslo University Hospital, Oslo, Norway; Department of Physical Medicine and Rehabilitation, Sørlandet Hospital, Kristiansand, Norway (Dr Knoph); Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway (Dr Anke); Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway (Dr Anke); Department of Physical Medicine and Rehabilitation, Trondheim University Hospital, Trondheim, Norway (Dr Skandsen); Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway (Dr Skandsen); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts (Dr Giacino); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (Dr Giacino); and Faculty of Medicine, University of Oslo, Oslo, Norway (Dr Røe).
出版信息
J Head Trauma Rehabil. 2014 Sep-Oct;29(5):E31-43. doi: 10.1097/HTR.0000000000000017.
OBJECTIVE
Establish rate of disorders of consciousness (DOC) and course of recovery in adults who have sustained severe traumatic brain injury (sTBI).
SETTING
Four Norwegian neurosurgical departments.
PARTICIPANTS
Vegetative or minimally conscious patients.
DESIGN
Prospective, longitudinal population-based study of adults with sTBI with follow-ups at 3, 12, and 24-36 months postinjury.
MAIN MEASURES
Coma Recovery Scale-Revised, Glasgow Coma Scale, Extended Glasgow Outcome Scale, and Disability Rating Scale.
RESULTS
Three months postinjury, 2% of the sTBI population remained in a vegetative or minimally conscious state, reduced by the half after 1 year, corresponding to average annual age-adjusted incidence rates of DOC of 0.09 per 100 000 3 months post-sTBI. At 3 and 12 months, the incidence was 0.06 and 0.01 per 100 000 for the vegetative state and 0.03 and 0.04 per 100 000 for the minimally conscious state. Diagnostic categorization was stable between 12 and 24-36 months, although clinically relevant improvements were observed in minimally conscious patients.
CONCLUSION
The data suggest that prolonged DOC is rare following sTBI in Norway, contrary to the commonly held belief that improvements in intensive care treatment have resulted in an increased incidence of DOC. Prolonged DOC was associated with severity of injury, subcortical lesions, and diffuse axonal injury.
目的
确定重度创伤性脑损伤（sTBI）成年患者的意识障碍（DOC）发生率及恢复过程。
地点
挪威四个神经外科科室。
参与者
植物状态或微意识状态患者。
设计
对成年sTBI患者进行前瞻性、基于人群的纵向研究，在受伤后3个月、12个月以及24 - 36个月进行随访。
主要测量指标
昏迷恢复量表修订版、格拉斯哥昏迷量表、扩展格拉斯哥预后量表及残疾评定量表。
结果
受伤后3个月，2%的sTBI患者仍处于植物状态或微意识状态，1年后这一比例减半，相当于sTBI后3个月DOC的年龄调整后平均年发病率为每10万人0.09例。在3个月和12个月时，植物状态的发病率分别为每10万人0.06例和0.01例，微意识状态的发病率分别为每10万人0.03例和0.04例。尽管在微意识患者中观察到了临床相关改善，但诊断分类在12个月至24 - 36个月之间保持稳定。
结论
数据表明，在挪威，sTBI后长期存在DOC的情况很少见，这与普遍认为的重症监护治疗的改善导致DOC发病率增加的观点相反。长期DOC与损伤严重程度、皮质下病变及弥漫性轴索损伤有关。
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