Neurorehabilitation Unit and Research Laboratory for Disorder of Consciousness, IRCCS Maugeri ICS, Telese Terme (BN), Italy.
Neurorehabilitation Unit and Research Laboratory for Disorder of Consciousness, IRCCS Maugeri ICS, Telese Terme (BN), Italy.
Arch Phys Med Rehabil. 2018 Dec;99(12):2523-2531.e3. doi: 10.1016/j.apmr.2018.04.024. Epub 2018 May 26.
To investigate medical complications (MCs) occurring within 6 months postinjury in brain-injured patients with prolonged disorders of consciousness (DoC) and to evaluate impact of MC on mortality and long-term clinical outcomes.
Prospective observational cohort study.
Rehabilitation unit for acquired DoC.
Patients (N=194) with DoC (142 in vegetative state [VS], 52 in minimally conscious state; traumatic etiology 43, anoxic 69, vascular 82) consecutively admitted to a neurorehabilitation unit within 1-3 months postonset.
Not applicable.
Mortality and improvements in clinical diagnosis and functional disability level (assessed by Coma Recovery Scale-Revised [CRS-R] and Disability Rating Scale) at 12, 24, and 36 months postonset.
Within 6 months postinjury, 188 of 194 patients (>95%) developed at least 1 MC and 142 of them (73%) showed at least 1 severe MC. Respiratory and musculoskeletal-cutaneous MCs were the most frequent, followed by endocrino-metabolic abnormalities. Follow-up, complete in 189 of 194 patients, showed that male sex and endocrine-metabolic MCs were associated with higher risk of mortality at all timepoints. Old age, anoxic etiology, lower CRS-R total scores, and diagnosis of VS at study entry predicted no clinical and functional improvements at most timepoints; however, epilepsy predicted no improvement in diagnosis at 24 months postonset only.
MCs are very frequent in patients with DoC within at least 6 months after brain injury, regardless of clinical diagnosis, etiology, and age. Endocrino-metabolic MCs are independent predictors of mortality at all timepoints; however,epilepsy predicted poor long-term outcome. Occurrence and severity of MCs in patients with DoC call for long-term appropriate levels of care after the postacute phase.
调查脑损伤后长时间意识障碍（DOC）患者伤后 6 个月内发生的医疗并发症（MCs），并评估 MC 对死亡率和长期临床结局的影响。
前瞻性观察队列研究。
获得性 DOC 康复单元。
DOC 患者（142 例处于植物状态[VS]，52 例处于最小意识状态；创伤性病因 43 例，缺氧性病因 69 例，血管性病因 82 例）连续入组，在发病后 1-3 个月内进入神经康复单元。
无。
发病后 12、24 和 36 个月的死亡率和临床诊断及功能残疾水平（通过昏迷恢复量表修订版[CRS-R]和残疾评定量表评估）的改善。
伤后 6 个月内，194 例患者中有 188 例（>95%）至少发生了 1 次 MC，其中 142 例（73%）至少发生了 1 次严重 MC。呼吸和肌肉骨骼-皮肤 MC 最常见，其次是内分泌代谢异常。在 194 例患者中有 189 例（97%）完成了随访，结果显示男性、内分泌代谢 MC 与所有时间点的死亡率增加相关。高龄、缺氧性病因、CRS-R 总评分较低和研究开始时诊断为 VS 预测大多数时间点无临床和功能改善；然而，只有在发病后 24 个月时癫痫预测诊断无改善。
DOC 患者在脑损伤后至少 6 个月内发生 MCs 的频率非常高，无论其临床诊断、病因和年龄如何。内分泌代谢 MC 是所有时间点死亡率的独立预测因素；然而，癫痫预测长期预后不良。DOC 患者 MCs 的发生和严重程度需要在急性期后提供长期适当的护理水平。
