Gantois Guillaume, Parmentier-Decrucq Erika, Duburcq Thibault, Favory Raphaël, Mathieu Daniel, Poissy Julien
Intensive Care Unit and Hyperbaric Center, Lille University Hospital, F-59037 Lille cedex, France.
Intensive Care Unit and Hyperbaric Center, Lille University Hospital, F-59037 Lille cedex, France.
Am J Emerg Med. 2017 Nov;35(11):1672-1676. doi: 10.1016/j.ajem.2017.05.037. Epub 2017 May 23.
Patients surviving a self-attempted hanging have a total neurological recovery in 57-77% of cases at hospital discharge, but no long-term data are available.
In this observational study, all patients hospitalized post-self-attempted hanging in the intensive care unit (ICU) in a 5-year period were included. Neurological evaluations at 6 and 12months were performed according to Cerebral Performance Category (CPC) scores. Factors associated with neurological recovery were determined by comparing CPC2+3+4 (bad recovery) vs. CPC1 (good recovery).
Of 231 patients included, 104 (47%) were found to have cardiac arrest (CA). Ninety-five (41%) patients died in the ICU: 93 (89%) in the CA group and 2 (1.6%) in the group without CA. Neurological evaluations at 6 and 12months were obtained in 97 of the 136 surviving patients. At 6months, in the CA group (n=9), the CPC score was 1 for 6 patients, 2 for 2, and 4 for 1 patient. In the group without CA (n=88), 79 patients had normal neurological status at 6months and 78 at 12months. Among these patients, 96% returned home, 77% returned to work, 16 (18%) patients re-attempted suicide within the year. Risk factors of neurological sequelae at 6months were a CA at the hanging site (P=0.045), an elevated diastolic blood pressure (87 vs. 70 mm Hg; P=0.04), a lower initial Glasgow score (4 vs. 5; P=0.04), and an elevated blood glucose level (139 vs. 113 mg/dL; P<0.001).
Patients surviving a self-attempted hanging who did not have a CA had a good neurological outcome. The rate of suicidal recidivism is particularly important, which justifies joint work with psychiatrists.
在自行上吊未遂后存活的患者中，57%至77%在出院时神经功能完全恢复，但尚无长期数据。
在这项观察性研究中，纳入了5年内因自行上吊未遂而入住重症监护病房（ICU）的所有患者。根据脑功能分类（CPC）评分在6个月和12个月时进行神经功能评估。通过比较CPC2+3+4（恢复不佳）与CPC1（恢复良好）来确定与神经功能恢复相关的因素。
在纳入的231例患者中，104例（47%）发生心脏骤停（CA）。95例（41%）患者在ICU死亡：CA组93例（89%），无CA组2例（1.6%）。136例存活患者中的97例在6个月和12个月时进行了神经功能评估。在6个月时，CA组（n=9）中，6例患者的CPC评分为1，2例为2，1例为4。在无CA组（n=88）中，79例患者在6个月时神经功能正常，78例在12个月时正常。在这些患者中，96%回家，77%恢复工作，16例（18%）患者在一年内再次自杀未遂。6个月时神经后遗症的危险因素包括上吊现场发生CA（P=0.045）、舒张压升高（87 vs. 70 mmHg；P=0.04）、初始格拉斯哥评分较低（4 vs. 5；P=0.04）以及血糖水平升高（139 vs. 113 mg/dL；P<0.001）。
自行上吊未遂后存活且未发生CA的患者神经功能预后良好。自杀复发率尤为重要，这证明了与精神科医生联合工作的合理性。
