Wang Jianan, Wang Jing, Hu Xiaohua, Xu Lingqi, Tian Jinna, Li Jiayin, Fang Danruo, Huang Wangshan, Sun Yuxiao, He Minhui, Laureys Steven, Di Haibo
International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China.
Rehabilitation Center for Brain Damage, Wujing Hospital of Hangzhou City, Hangzhou, China.
Front Neurol. 2019 Nov 14;10:1184. doi: 10.3389/fneur.2019.01184. eCollection 2019.
To detect the initiation of swallowing in patients with disorders of consciousness (DOC) as well as the relationship between the initiation of swallowing and the prognosis of DOC patients. Nineteen DOC patients were included in this study, and a self-controlled trial compared five different stimuli. The five different stimuli were as follows: (1) one command, as recommended by the Coma Recovery Scale-Revised (CRS-R), which was "open your mouth"; (2) placing a spoon in front of the patient's mouth without a command; (3) placing a spoon filled with water in front of the patient's mouth without a command; (4) one command-"there is a spoon; open your mouth"-with a spoon in front of the patient's mouth; (5) one command, "there is a spoon with water; open your mouth," with a spoon filled with water in front of the patient's mouth. All 19 patients were given these five stimuli randomly, and any one of the commands was presented four times to a patient, one at a time, at 15-s intervals. The sensitivity and specificity of the initiation of swallowing in detecting conscious awareness were determined. None of the patients responded to the first four stimuli. However, six patients showed initiated swallowing toward the fifth stimulus. Among those six, five patients showed improvement in their consciousness state 6 months later. The sensitivity and specificity of the initiation of swallowing for DOC patients was 83.33% [95% CIs (36%, 100%)] and 92.31% [95% CIs (64%, 100%)], respectively. The initiation of swallowing can be an early indication of conscious behavior and can likely provide evidence of conscious awareness. www.ClinicalTrials.gov, identifier: NCT03508336; Date of registration: 2018/4/16.
检测意识障碍（DOC）患者吞咽动作的起始情况以及吞咽动作起始与DOC患者预后之间的关系。本研究纳入了19例DOC患者，并采用自身对照试验比较了五种不同的刺激方式。五种不同的刺激方式如下：（1）按照修订版昏迷恢复量表（CRS-R）的建议发出一个指令，即“张开嘴”；（2）在未发出指令的情况下将一把勺子放在患者嘴前；（3）在未发出指令的情况下将一把盛有水的勺子放在患者嘴前；（4）发出一个指令——“有一把勺子；张开嘴”，同时在患者嘴前放一把勺子；（5）发出一个指令，“有一把盛有水的勺子；张开嘴”，同时在患者嘴前放一把盛有水的勺子。对所有19例患者随机给予这五种刺激，每个指令对一名患者各呈现4次，每次间隔15秒依次呈现。确定吞咽动作起始在检测意识觉醒方面的敏感性和特异性。前四种刺激方式下所有患者均无反应。然而，有6例患者对第五种刺激表现出吞咽动作起始。在这6例患者中，5例患者在6个月后意识状态有所改善。DOC患者吞咽动作起始的敏感性和特异性分别为83.33% [95%置信区间（36%，100%）]和92.31% [95%置信区间（64%，100%）]。吞咽动作起始可能是意识行为的早期指标，并可能为意识觉醒提供证据。ClinicalTrials.gov网站，标识符：NCT03508336；注册日期：2018年4月16日。
