入院时血液酒精含量对创伤性脑损伤患者长期认知功能的不良影响。

Adverse effects of admission blood alcohol on long-term cognitive function in patients with traumatic brain injury.

作者信息

Joseph Bellal, Khalil Mazhar, Pandit Viraj, Kulvatunyou Narong, Zangbar Bardiya, O'Keeffe Terence, Asif Anum, Tang Andrew, Green Donald J, Gries Lynn, Friese Randall S, Rhee Peter

机构信息

From the Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.

出版信息

J Trauma Acute Care Surg. 2015 Feb;78(2):403-8. doi: 10.1097/TA.0000000000000504.

DOI:10.1097/TA.0000000000000504

PMID:25757129

Abstract

BACKGROUND

Alcohol is known to be protective in patients with traumatic brain injury (TBI); however, its impact on the long-term cognitive function is unknown. We hypothesize that intoxication at the time of injury is associated with adverse long-term cognitive function in patients sustaining TBI.

METHODS

We performed a 2-year retrospective study of all trauma patients with isolated TBI presenting to our Level I trauma center and discharged to a single rehabilitation facility. Patients with moderate-to-severe TBI (head Abbreviated Injury Scale [AIS] score ≥ 3), measured admission blood alcohol concentration, and measured cognitive function on hospital discharge and rehabilitation center discharge were included. Cognitive function was assessed using Functional Independence Measure (FIM) scores. Delta cognitive FIM was defined as the difference between rehabilitation center discharge and hospital discharge cognitive FIM scores. Multivariate linear regression was performed.

RESULTS

A total of 64 patients were included. Mean (SD) age was 51.8 (23) years, median head AIS score was 3 (IQR, 3-5), and median Glasgow Coma Scale (GCS) score was 11 (IQR, 3-15). Mean (SD) cognitive FIM score on hospital discharge was 17 (6), and mean (SD) cognitive improvement was 8.6 (4.7). Sixty percent (n = 39) were under the influence of alcohol on admission, and the mean (SD) admission blood alcohol concentration was 132 (102).On multivariate linear regression analysis, admission blood alcohol concentration (β = -0.4; 95% confidence interval, -6.7 to -0.8; p = 0.01) and age (β = -0.13; 95% confidence interval, -0.2 to -0.04; p = 0.04) were negatively associated with improvement in long-term cognitive function.

CONCLUSION

Alcohol intoxication at the time of injury is associated with lower improvement in long-term cognitive function. Older intoxicated patients are likely to have a lower cognitive improvement.

LEVEL OF EVIDENCE

Prognostic and epidemiologic study, level III.

摘要

背景

已知酒精对创伤性脑损伤（TBI）患者具有保护作用；然而，其对长期认知功能的影响尚不清楚。我们假设受伤时醉酒与TBI患者长期认知功能不良有关。

方法

我们对所有入住我院一级创伤中心并转至单一康复机构的单纯TBI创伤患者进行了为期2年的回顾性研究。纳入中度至重度TBI（头部简明损伤量表[AIS]评分≥3）、测量入院时血酒精浓度以及出院时和康复中心出院时测量认知功能的患者。使用功能独立性测量（FIM）评分评估认知功能。认知FIM差值定义为康复中心出院时与出院时认知FIM评分的差值。进行多变量线性回归分析。

结果

共纳入64例患者。平均（标准差）年龄为51.8（23）岁，头部AIS评分中位数为3（四分位间距，3 - 5），格拉斯哥昏迷量表（GCS）评分中位数为11（四分位间距，3 - 15）。出院时平均（标准差）认知FIM评分为17（6），平均（标准差）认知改善为8.6（4.7）。60%（n = 39）的患者入院时受酒精影响，入院时平均（标准差）血酒精浓度为132（102）。多变量线性回归分析显示，入院时血酒精浓度（β = -0.4；95%置信区间，-6.7至-0.8；p = 0.01）和年龄（β = -0.13；95%置信区间，-0.2至-0.04；p = 0.04）与长期认知功能改善呈负相关。