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植物状态或微意识状态患者长期病情演变的人口统计学和临床指标。

Demographical and clinical indices for long-term evolution of patients in vegetative or in minimally conscious state.

作者信息

Estraneo A, De Bellis F, Masotta O, Loreto V, Fiorenza S, Lo Sapio M, Trojano L

机构信息

Disorders of Consciousness Laboratory, Institute of Telese Terme, Maugeri Scientific and Clinical Institutes, IRCCS, Telese Terme (BN), Italy.

Department of Neurology, Santa Maria della Pietà General Hospital, Nola, Italy.

出版信息

Brain Inj. 2019;33(13-14):1633-1639. doi: 10.1080/02699052.2019.1658220. Epub 2019 Sep 19.

Abstract

. To evaluate the prognostic value of demographical, anamnestic, and clinical findings on long-term outcome (up to 36 months) in individuals with severe brain injury in vegetative state (VS) or in minimally conscious state (MCS).. Patients ( = 216) in VS ( = 159) or in MCS ( = 57) consecutively admitted to a neurorehabilitation unit within 1-3 months after severe anoxic ( = 71), vascular ( = 96), or traumatic ( = 49) brain injury.. Mortality and improvements in clinical diagnosis at 12, 24, and 36 months after brain injury. Multivariable logistic regression analyses were performed to verify independent relationships of variables collected at study entry with outcome measures.. In patients in VS, at the 12-month follow-up, higher level of responsiveness assessed by the Coma Recovery Scale-Revised (CRS-R) total scores at study entry predicted a higher likelihood of both survival and clinical improvement, whereas younger age predicted survival only. At 24 months, female sex and higher CRS-R total scores tended to be associated with clinical improvements. In patients in MCS, younger age and female predicted consciousness recovery at 12 months.. Several patients' features easy to collect in rehabilitation setting might help clinicians in prognostication of long-term mortality and clinical evolution of VS and MCS.

摘要

评估人口统计学、既往史及临床检查结果对处于植物状态(VS)或最低意识状态(MCS)的重型脑损伤患者长期预后(长达36个月)的预测价值。在严重缺氧性脑损伤(71例)、血管性脑损伤(96例)或创伤性脑损伤(49例)后1至3个月内,连续入住神经康复科的VS患者(159例)或MCS患者(57例)。观察脑损伤后12个月、24个月和36个月时的死亡率及临床诊断改善情况。进行多变量逻辑回归分析,以验证研究入组时收集的变量与预后指标之间的独立关系。在VS患者中,12个月随访时,研究入组时通过修订版昏迷恢复量表(CRS-R)总分评估的较高反应水平预示着生存和临床改善的可能性更高,而较年轻的年龄仅预示着生存。在24个月时,女性性别和较高的CRS-R总分往往与临床改善相关。在MCS患者中,较年轻的年龄和女性预示着12个月时意识恢复。在康复环境中易于收集的一些患者特征可能有助于临床医生对VS和MCS患者的长期死亡率及临床演变进行预后判断。

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