由缺血缺氧性脑病导致的意识障碍患者意识恢复的相关因素分析

Influencing factors for recovery of consciousness in patients with disturbance of consciousness caused by hypoxic-ischemic encephalopathy

摘要:

目的 探讨由缺血缺氧性脑病导致的意识障碍患者的临床特点及影响意识康复的相关因素。方法 回顾性分析2013年10月至2018年10月在南部战区总医院神经康复一科住院的46例由缺血缺氧性脑病导致慢性意识障碍患者的临床资料，采用二元logistic回归方法对可能影响意识恢复的相关因素进行分析。结果 单因素分析显示植物状态持续时间（P<0.001）、发病至神经康复时间（P=0.001）、（CRS-R）评分（P=0.016）、性别（P=0.034）、阵发性交感神经过度兴奋（P=0.016）、体感诱发电位（P=0.002）和脑电图（P=0.003）与意识恢复相关，差异具有统计学意义（P<0.05）。logistic回归分析显示，植物状态持续时间（OR=1.077，95%CI：1.009~1.148，P=0.025）、阵发性交感神经过度兴奋（OR=15.511，95%CI：1.210~198.833，P=0.035）是意识恢复的独立影响因素。结论 植物状态持续时间过长、阵发性交感神经过度兴奋的出现是影响缺血缺氧性脑病慢性意识障碍患者意识恢复的临床指标。

Abstract:

Objective To investigate the clinical features of patients with disturbance of consciousness caused by hypoxic-ischemic encephalopathy and the influencing factors for recovery of consciousness.Methods A retrospective analysis was performed for the clinical data of 46 patients with chronic disturbance of consciousness caused by hypoxic-ischemic encephalopathy who were admitted to First Department of Neurological Rehabilitation in General Hospital of Southern Theatre Command from October 2013 to October 2018. A binary logistic regression analysis was used to investigate the influencing factors for recovery of consciousness.Results The univariate analysis showed that duration of vegetative state (P<0.001), time from onset to neurological rehabilitation (P=0.001), coma recovery scale revised (CRS-R) score (P=0.016), sex (P=0.034), paroxysmal sympathetic hyperactivity (P=0.016), somatosensory evoked potential (P=0.002), and electroencephalography findings (P=0.003) were associated with recovery of consciousness. The logistic regression analysis showed that duration of vegetative state (odds ratio[OR]=1.077, 95% confidence interval[CI]:1.009-1.148,P=0.025) and paroxysmal sympathetic hyperactivity(OR=15.511,95%CI:1.210-198.833,P=0.035) were independent influencing factors for recovery of consciousness.Conclusions A long duration of vegetative state and paroxysmal sympathetic hyperactivity are clinical factors that affect the recovery of consciousness in patients with chronic disturbance of consciousness caused by hypoxic-ischemic encephalopathy.