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多中心研究不同病因迁延性意识障碍患者的整体临床复杂性。

Multi-center study on overall clinical complexity of patients with prolonged disorders of consciousness of different etiologies.

机构信息

Department of Acquired Brain Injury, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.

Neurology Unit, Santa Maria Della Pietà General Hospital, Nola, Italy.

出版信息

Brain Inj. 2021 Jan 5;35(1):1-7. doi: 10.1080/02699052.2020.1861652. Epub 2020 Dec 17.

DOI:
10.1080/02699052.2020.1861652
PMID:33331792
Abstract

: to assess overall clinical complexity of patients with acquired disorders of consciousness (DoC) in vegetative state/unresponsive wakefulness syndrome (VS/UWS) vs. minimally conscious state- MCS) and in different etiologies.. Multi-center cross-sectional observational study.: 23 intensive neurorehabilitation units.: 264 patients with DoC in the post-acute phase: VS/UWS = 141, and MCS = 123 due to vascular (n = 125), traumatic (n = 83) or anoxic (n = 56) brain injury.: Coma Recovery Scale-Revised, and Disability Rating Scale (DRS); presence of medical devices (e.g., for eating or breathing); occurrence and severity of medical complications.: patients in DoC, and particularly those in VS/UWS, showed severe overall clinical complexity. Anoxic patients had higher overall clinical complexity, lower level of responsiveness/consciousness, higher functional disability, and higher needs of medical devices. Vascular patients had worse premorbid clinical comorbidities. The two etiologies showed a comparable rate of MC, higher than that observed in traumatic etiology.: overall clinical complexity is significantly higher in VS/UWS than in MCS, and in non-traumatic vs. traumatic etiology. These findings could explain the worse clinical evolution reported in anoxic and vascular etiologies and in VS/UWS patients and contribute to plan patient-tailored care and rehabilitation programmes.

摘要

评估获得性意识障碍(DoC)患者的整体临床复杂性,包括处于植物状态/无反应觉醒综合征(VS/UWS)与最小意识状态(MCS)的患者,以及不同病因的患者。多中心横断面观察性研究。 23 个强化神经康复单位。 264 名处于急性后阶段的 DoC 患者:VS/UWS = 141 例,MCS = 123 例,分别归因于血管性(n = 125)、创伤性(n = 83)或缺氧性(n = 56)脑损伤。昏迷恢复量表修订版(CRS-R)和残疾评定量表(DRS);存在医疗设备(例如,用于进食或呼吸);医疗并发症的发生和严重程度。处于 DoC 的患者,特别是处于 VS/UWS 的患者,表现出严重的整体临床复杂性。缺氧性患者的整体临床复杂性更高,意识和反应能力更低,功能残疾程度更高,对医疗设备的需求更高。血管性患者的发病前临床合并症更严重。这两种病因的 MC 发生率可比,高于创伤性病因。 总体临床复杂性在 VS/UWS 中显著高于 MCS,在非创伤性病因中显著高于创伤性病因。这些发现可以解释在缺氧性和血管性病因以及 VS/UWS 患者中报告的更差的临床转归,并有助于制定针对患者的护理和康复计划。

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