Lin Miaoyuan, Lu Qiongna, Yu Sheng, Lin Wenjuan
Department of Neurosurgery, Shenzhen Nanshan People's Hospital, Shenzhen, Guangdong, People's Republic of China.
School of Health, Guangzhou Vocational and Technical University of Science and Technology, Guangzhou, Guangdong, People's Republic of China.
Brain Behav. 2025 Jan;15(1):e70260. doi: 10.1002/brb3.70260.
The treatment effect of consciousness after brain injury is currently uncertain. Thus, this study aimed to retrieve the evidence from neurologists around the world on the management of consciousness disorders in patients with severe brain injury and evaluate and summarize the evidence, providing the guidance on the related management for clinicians.
Following the evidence summary report standard of Fudan University Center for Evidence-Based Nursing, clinical guidelines, expert consensuses, systematic reviews, and evidence summaries were systematically retrieved from UpToDate; BMJ Best Practice; Guidelines International Network; the Cochrane Library; Embase; PubMed; Sinomed; Web of Science; CNKI; WanFang database; American Academy of Neurology (AAN); American Congress of Rehabilitation Medicine (ACRM); European Academy of Neurology; and National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). The publishing timeline for articles was limited from January 2017 to January 2024.
Fourteen articles were finally identified. The 26 best pieces of evidence were recommended by inducting and integrating the evidence from these articles, covering the following seven aspects: consciousness assessment, multidisciplinary team, intervention in facilitating arousal, sensory stimulation programs, drug administration, rehabilitation program, and prevention of complications.
This study summarized the evidence of consciousness management in patients with brain injury, providing guidance for clinicians to develop and apply those interventions to improve the patient's clinical outcomes and quality of life. In addition, relevant factors such as the clinical environment and cooperation with the patient's family members should be evaluated and adjusted before applying such evidence. Future studies should focus on more targeted randomized clinical trials.
脑损伤后意识的治疗效果目前尚不确定。因此，本研究旨在检索全球神经科医生关于重型脑损伤患者意识障碍管理的证据，并对证据进行评估和总结，为临床医生的相关管理提供指导。
按照复旦大学循证护理中心的证据总结报告标准，从UpToDate、BMJ最佳实践、指南国际网络、考克兰图书馆、Embase、PubMed、中国生物医学文献数据库、科学引文索引、中国知网、万方数据库、美国神经病学学会（AAN）、美国康复医学大会（ACRM）、欧洲神经病学学会以及美国国立残疾、独立生活和康复研究所（NIDILRR）系统检索临床指南、专家共识、系统评价和证据总结。文章发表时间限制在2017年1月至2024年1月。
最终纳入14篇文章。通过归纳整合这些文章的证据，推荐了26条最佳证据，涵盖意识评估、多学科团队、促醒干预、感觉刺激方案、药物治疗、康复方案以及并发症预防七个方面。
本研究总结了脑损伤患者意识管理的证据，为临床医生制定和应用这些干预措施以改善患者临床结局和生活质量提供了指导。此外，在应用此类证据前，应评估并调整临床环境及与患者家属合作等相关因素。未来研究应聚焦于更具针对性的随机临床试验。
