重度脑外伤患者长期功能结局的影响因素

doi:10.3969/j.issn.1006-9771.2020.09.016

摘要/Abstract

摘要：

目的了解重度脑外伤患者1年随访结局及其相关因素。
方法 2015年1月至2018年12月,重度脑外伤患者135例,住院期间记录性别、发病年龄、教育年限、损伤部位、病变侧,并采用残疾等级量表(DRS)、简易精神状态检查(MMSE)、Fugl-Meyer评定量表(FMA)运动和平衡部分,以及改良Barthel指数(MBI)进行评定。出院后随访1年,再次评定DRS。
结果发病年龄(r = 0.188)、初次DRS评分(r = 0.530)、MMSE评分(r = -0.376)、FMA运动部分评分(r = -0.284)、FMA平衡部分评分(r = -0.425)、MBI评分(r = -0.480)、脑干受损(r = 0.194)、弥漫性脑损伤(r = 0.202)与随访时DRS评分相关(P < 0.05);性别( r = -0.175)、初次DRS评分(r = 0.586)、MMSE评分(r = -0.242)、FMA运动部分评分(r = -0.301)、FMA平衡部分评分(r = -0.228)、MBI评分(r = -0.367)、枕叶受损(r = 0.209)与DRS差值相关(P < 0.05)。
结论重度脑外伤患者的受伤年龄、早期认知和运动功能障碍程度,影响患者长期结局,仍需进一步研究损伤部位对长期结局的影响。

关键词: 脑外伤, 残疾等级量表, 相关因素, 结局

Abstract:

Objectives To investigate the factors related to the long-term outcome for patients after severe traumatic brain injury.
Methods From January, 2015 to December, 2018, 135 patients with severe traumatic brain injury were selected. Their gender, age (of onset), education level, injury sites, and lesion side were recorded, and they were assessed with Disability Rating Scale (DRS), Mini-Mental State Examination (MMSE), Fugl-Meyer Assessment (FMA) for motor and balance and modified Barthel Index (MBI). They were assessed with DRS again one year after discharge.
Results The age (r = 0.188), early DRS score (r = 0.530), MMSE score (r = -0.376), FMA for motor (r = -0.284) and balance (r = -0.425) score, MBI score (r = -0.480), brain stem injury (r = 0.194) and diffuse brain injury (r = 0.202) were related to DRS scores as follow-up (P < 0.05); while, the gender ( r = -0.175), early DRS score (r = 0.586), MMSE score (r = -0.242), FMA for motor (r = -0.301) and balance (r = -0.228) score, MBI score (r = -0.367) and occipital lobe injury (r = 0.209) were related to difference of DRS (P < 0.05).
Conclusion The age, early cognitive and motor dysfunction are related with the outcome of one year of patients after severe traumatic brain injury. More researches are needed to explore the impact of injury sites on the outcome.

Key words: traumatic brain injury, Disability Rating Scale, related factors, outcome

张欣,张小年,孙新亭,迟茜茜. 重度脑外伤患者长期功能结局的影响因素[J]. 《中国康复理论与实践》, 2020, 26(9): 1089-1092.

ZHANG Xin,ZHANG Xiao-nian,SUN Xin-ting,CHI Qian-qian. Influence Factors Related to Long-term Outcome for Patients with Severe Traumatic Brain Injury[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(9): 1089-1092.

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参考文献 19

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变量	变量值	赋值	变量	变量值	赋值
性别(n)			累及部位(n)		是 = 1,否 = 0
男	108	1	额叶	77
女	27	0	颞叶	86
发病年龄(岁)	34.63±15.79	数值变量	顶叶	58
教育年限(年)	11.52±4.14	数值变量	枕叶	32
昏迷时间(d)	28.38±57.69	数值变量	基底节	25
损伤侧(n)		是 = 1,否 = 0	脑干	18
左侧	50		小脑	6
右侧	45		弥散性损害	8
双侧	40		初次DRS评分	11.49±6.59	数值变量
FMA运动评分	58.49±31.17	数值变量	随访时DRS评分	6.88±5.55	数值变量
FMA平衡评分	6.74±4.88	数值变量	MMSE评分	19.10±8.52	数值变量
MBI评分	45.62±30.82	数值变量

自变量	r值	P值	自变量	r值	P值
性别	0.056	0.517	损伤累及部位
发病年龄	0.188	0.029	额叶	-0.033	0.705
教育年限	-0.120	0.174	颞叶	-0.108	0.216
昏迷时间	0.171	0.055	顶叶	-0.081	0.352
受伤侧			枕叶	-0.089	0.307
左侧	-0.065	0.452	基底节	-0.020	0.819
右侧	-0.148	0.088	脑干	0.194	0.025
双侧	0.155	0.074	小脑	0.002	0.981
FMA运动评分	-0.284	0.001	弥散性损害	0.202	0.020
FMA平衡评分	-0.425	< 0.001	初次DRS评分	0.530	< 0.001
MBI评分	-0.480	< 0.001	MMSE评分	-0.376	< 0.001

自变量	r值	P值	自变量	r值	P值
性别	-0.175	0.043	损伤累及部位
发病年龄	-0.027	0.752	额叶	0.077	0.377
教育年限	0.039	0.659	颞叶	0.063	0.467
昏迷时间	0.161	0.071	顶叶	0.094	0.280
受伤侧			枕叶	0.209	0.016
左侧	-0.045	0.605	基底节	0.054	0.534
右侧	-0.063	0.473	脑干	-0.090	0.305
双侧	0.034	0.693	小脑	-0.029	0.739
FMA运动评分	-0.301	0.007	弥散性损害	0.130	0.136
FMA平衡评分	-0.228	0.010	初次DRS评分	0.586	< 0.001
MBI评分	-0.367	< 0.001	MMSE评分	-0.242	0.013