Norris Jacob N, Sams Richard, Lundblad Peter, Frantz Earl, Harris Erica
Neurotrauma Department, Naval Medical Research Centre , Silver Spring, MD , USA .
Brain Inj. 2014;28(8):1052-62. doi: 10.3109/02699052.2014.891761. Epub 2014 Mar 21.
The objective was to compare symptoms in service members diagnosed with a blast-related mTBI (mild traumatic brain injury) with a loss of consciousness (LOC) to those without LOC.
Clinicians saw US military personnel within 72 hours of sustaining a blast-related mTBI and at a follow-up visit 48-72 hours later (n = 210).
Demographics, post-concussive symptoms, diagnosis of acute stress reaction (ASR) and simple reaction time data from the Automated Neuropsychological Assessment Metric (ANAM) were collected.
ASRs were significantly more likely in patients reporting LOC versus patients reporting no LOC. At the first post-injury visit, LOC was associated with difficulty sleeping, hearing loss, memory problems and reporting more symptoms. A follow-up analysis explored if symptomatic differences were influenced by ASR. Adjusting for ASR, the statistical relationships between LOC and symptoms were weaker (i.e. reduced Odds Ratios). At the follow-up visit, difficulty sleeping was associated with LOC before and after adjusting for ASR. Patients with both ASR and LOC had the slowest simple reaction times.
Results suggest ASR may partially mediate symptom presentation and cognitive dysfunction in the acute phase following blast-related mTBI. Future research is warranted.
本研究旨在比较诊断为与爆炸相关的轻度创伤性脑损伤（mTBI）且伴有意识丧失（LOC）的军人与无LOC的军人的症状。
临床医生在军人遭受与爆炸相关的mTBI后72小时内对其进行检查，并在48 - 72小时后的随访中再次检查（n = 210）。
收集人口统计学数据、脑震荡后症状、急性应激反应（ASR）诊断以及自动神经心理评估指标（ANAM）的简单反应时间数据。
报告有LOC的患者比报告无LOC的患者发生ASR的可能性显著更高。在首次受伤后的就诊中，LOC与睡眠困难、听力丧失、记忆问题以及报告更多症状有关。一项随访分析探讨了症状差异是否受ASR影响。在对ASR进行校正后，LOC与症状之间的统计关系变弱（即优势比降低）。在随访就诊时，在对ASR进行校正前后，睡眠困难均与LOC有关。同时患有ASR和LOC的患者简单反应时间最慢。
结果表明，ASR可能在与爆炸相关的mTBI急性期部分介导症状表现和认知功能障碍。有必要进行进一步研究。
