Xu Rao, Sun Yi, Zhao Lin, Wang Ying, Yu Danjing, Chen Yunxiang, Bi Liqing, Shen Zhiyan, Zhang Xintong, Yan Wei, Wang Xi
Department of Rehabilitation Medicine, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian 223800, China.
Department of Neurosurgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China.
Neural Plast. 2025 Apr 24;2025:8144313. doi: 10.1155/np/8144313. eCollection 2025.
There currently lacks the prognosis assessment of hypertensive intracerebral hemorrhage (HICH) with acute disorders of consciousness (DoC) after early rehabilitation (ER). The present study aims to investigate the outcomes of consciousness and neurological and cognitive functions in HICH patients with acute DoC intervened with ER via a retrospective cohort study with propensity score matching (PSM). A total of 265 eligible HICH patients with acute DoC admitted to the First Affiliated Hospital with Nanjing Medical University from January 2021 to December 2023 were retrospectively recruited. They were randomly divided into the ER group ( = 115) and the nonER group ( = 150) before PSM. After the PSM at a ratio of 1:1, 96 patients were allocated to each group. Baseline characteristics before and after PSM were compared between the ER group and the nonER group. Outcome measures included the duration of mechanical ventilation, and proportions of participants with an emergence to a conscious state (eMCS), 0-3 points of the modified Rankin Scale (mRS), and cognitive impairment. Baseline characteristics were comparable between the ER group and the nonER group after PSM ( ≥ 0.05). An ER significantly shortened the duration of mechanical ventilation (9 days vs. 10 days, =0.022). The neurological prognosis at 3 months of HICH combined with acute DoC was significantly improved by the ER, with a significantly higher proportion of participants grading 0-3 points of the mRS in the ER group than the nonER group (57.3% vs. 40.6%, =0.021). Among 174 participants who restored consciousness at 3 months of onset, a significantly lower proportion of cognitive impairment was detected in the ER group than the nonER group (25.8% vs. 53.2%, =0.002). An ER shortens the duration of mechanical ventilation and improves the neurological prognosis in HICH patients with acute DoC. Although the outcome of consciousness is unable to be improved, an ER does reduce the risk of residual cognitive dysfunction in HICH patients with acute DoC.
目前缺乏对早期康复（ER）后伴有急性意识障碍（DoC）的高血压性脑出血（HICH）患者的预后评估。本研究旨在通过倾向评分匹配（PSM）的回顾性队列研究，调查接受ER干预的急性DoC的HICH患者的意识、神经和认知功能结局。回顾性招募了2021年1月至2023年12月期间在南京医科大学第一附属医院收治的265例符合条件的急性DoC的HICH患者。在PSM之前，他们被随机分为ER组（n = 115）和非ER组（n = 150）。以1:1的比例进行PSM后，每组分配96例患者。比较ER组和非ER组PSM前后的基线特征。结局指标包括机械通气时间、出现意识状态（eMCS）的参与者比例、改良Rankin量表（mRS）0 - 3分以及认知障碍。PSM后，ER组和非ER组之间的基线特征具有可比性（P≥0.05）。ER显著缩短了机械通气时间（9天对10天，P = 0.022）。ER显著改善了HICH合并急性DoC患者3个月时的神经预后，ER组mRS评分为0 - 3分的参与者比例显著高于非ER组（57.3%对40.6%，P = 0.021）。在发病3个月时恢复意识的174名参与者中，ER组认知障碍的比例显著低于非ER组（25.8%对53.2%，P = 0.002）。ER缩短了急性DoC的HICH患者的机械通气时间并改善了神经预后。虽然意识结局无法改善，但ER确实降低了急性DoC的HICH患者残留认知功能障碍的风险。
