严重脑损伤 4 年预后的全面描述。PariS-TBI 研究结果。
A comprehensive picture of 4-year outcome of severe brain injuries. Results from the PariS-TBI study.
机构信息
Département de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France; UFR des sciences de la Santé-Simone Veil, HANDIReSP EA 4047, université de Versailles Saint-Quentin, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-Le-Bretonneux, France.
Laboratoire d'économie et de gestion des organisations de santé (LEDa-LEGOS), université Paris-Dauphine, 75016 Paris, France; Université Pierre-et-Marie-Curie, 75005 Paris, France; Service de médecine physique et de réadaptation, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, AP-HP, 75013 Paris, France.
出版信息
Ann Phys Rehabil Med. 2016 Apr;59(2):100-6. doi: 10.1016/j.rehab.2015.10.009. Epub 2015 Dec 17.
OBJECTIVES
Survivors of severe traumatic brain injury have a great variety of impairments and participation restrictions. Detailed descriptions of their long-term outcome are critical. We aimed to assess brain injury outcome for subjects with traumatic brain injury in terms of the International classification of functioning, disability and health.
MATERIALS AND METHODS
Four-year follow-up of an inception cohort of adults with severe traumatic brain injury by using face-to-face interviews with patients and proxies.
RESULTS
Among 245 survivors at 4 years, 147 were evaluated (80% male, mean age: 32.5±14.2 years at injury); 46 (32%) presented severe disability, 58 (40%) moderate disability, and 40 (28%) good recovery. Most frequent somatic problems were fatigue, headaches, other pain, and balance. One quarter of subjects had motor impairments. Rates of cognitive complaints ranged from 25 to 68%, the most frequent being memory, irritability, slowness and concentration. With the Hospital Anxiety and Depression Scale, 43% had anxiety and 25% depression. Overall, 79% were independent in daily living activities and 40 to 50% needed help for outdoor or organizational activities on the BICRO-39. Most had regular contacts with relatives or close friends but few contacts with colleagues or new acquaintances. Subjects spent little time in productive activities such as working, studying, looking after children or voluntary work. Quality of life on the QOLIBRI scale was associated with disability level (P<0.0001).
CONCLUSION
Management of late brain injury needs to focus on cognitive difficulties, particularly social skills, to enhance patient participation in life.
目的
严重创伤性脑损伤幸存者存在各种损伤和活动受限。详细描述其长期预后至关重要。我们旨在根据国际功能、残疾和健康分类评估创伤性脑损伤患者的脑损伤结局。
材料和方法
对严重创伤性脑损伤成人的队列进行 4 年随访，采用患者和代理人面对面访谈的方式进行。
结果
4 年后，245 名幸存者中有 147 名得到评估（80%为男性，损伤时的平均年龄为 32.5±14.2 岁）；46 名（32%）表现出严重残疾，58 名（40%）为中度残疾，40 名（28%）为良好恢复。最常见的躯体问题是疲劳、头痛、其他疼痛和平衡问题。四分之一的患者存在运动障碍。认知问题的发生率从 25%到 68%不等，最常见的是记忆力、易怒、反应迟钝和注意力不集中。使用医院焦虑抑郁量表，43%有焦虑，25%有抑郁。总体而言，79%的患者在日常生活活动中独立，40%至 50%的患者在 BICRO-39 上需要帮助进行户外活动或组织活动。大多数人定期与亲戚或亲密朋友保持联系，但很少与同事或新熟人保持联系。患者很少有时间从事生产性活动，如工作、学习、照顾孩子或志愿者工作。生活质量 QOLIBRI 量表评分与残疾程度相关（P<0.0001）。
结论
晚期脑损伤的管理需要重点关注认知困难，特别是社交技能，以提高患者的生活参与度。
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