脑震荡患者伤后遗忘时间与脑震荡综合征出现的关系

Association between posttraumatic amnesia time and occurrence of postconcussional syndrome in patients with concussion of brain

目的:以脑震荡患者伤后遗忘时间的各时间段为判断标准,观察伤后遗忘时间与脑震荡综合征出现症状类型和症状出现时间的联系。方法:以1999-06/2003-12河南省鹤壁矿务局总医院脑外科收治闭合性脑损伤脑震荡患者165例为观察对象。使用Galveston定向遗忘实验(10个题目,满分为100分,达到75分为脱离伤后遗忘)判断患者伤后遗忘时间长短。根据伤后遗忘时间不同(<5min,5～25min,26～50min,51～60min)将患者分为4个不同时段组,观察出院时、出院后6,12,18个月时脑震荡综合征出现情况。结果:165例患者全部完成18个月随访,进入结果分析。①按伤后遗忘时间不同分组情况:<5min的45例,5～25min的67例,26～50min的35例,51～60min的18例。②脑震荡综合征发生率:所有患者出院时与出院后6个月比较无差异(P>0.05)。伤后遗忘时间<5min和26～50min的患者出院12个月时有降低(χ2=4.15,P<0.05)。出院18个月时伤后遗忘时间<5min的患者明显低于26～50min的患者(χ2=14.37,P<0.01)。所有患者出院时与出院后12个月的头疼症状发生率比较有差异(χ2=6.53～5.19,P<0.05),其他症状发生率比较无差异(P>0.05)。遗忘时间<5min的患者出院时与出院后18个月时头疼和睡眠障碍发生率比较有差异(P<0.01)。结论:脑震荡患者伤后遗忘时间与脑震荡综合征出现症状类型和症状出现时间有着密切的关系,伤后遗忘时间越短的患者在出院一年半以后脑震荡综合征出现概率越小。在各伤后遗忘时间段的脑震荡患者脑震荡综合征迁延时间较长,半年内无明显改善。

AIM： To observe the associations of posttraumatic amnesia time with the type and appearance time of the symptoms of postconcussional syndrome by taking each time period of posttraumatic amnesia time in patients with concussion of brain as the criteria of judgement.METHODS： Totally 165 patients with concussion of brain after closed injury of brain were selected from the Department of Cerebral surgery,General Hospital of Hebi Bureau of Mine between June 1999 and December 2003. The length of amnesia time was judged with the Galveston orientation and amnesia test （consisted of 10 questions, the total score was 100 points, ≥ 75 points was taken as out of posttramatic amnesia）.According to the posttraumatic amnesia time, the patients were divided into g groups： 〈 5 minutes group, 5-25 minutes group, 26-50 minutes group, 51-60 minutes group, and the occurrence of postconcussional syndrome was observed at discharge and 6, 12 and 18 months after discharge respectively.RESULTS： All the 165 patients completed the 18-month follow-up, and were involved in the analysis of results. ① According to the posttraumatic amnesia time, the patients were divided into 〈 5 minutes group（n=g5）,5- 25 minutes group （n=67）, 26-50 minutes group （n=35）, 51-60 minutes group （n=18）. ② Incidence rate of posteoncussional syndrome： There was insignificant difference among all the patients at discharge and 6 months after discharge （P 〉 0.05）. At 12 months after discharge, it was decreased in the 〈 5 minutes group and 26-50 minutes group （χ^2=-4.15, P〈 0.05）. At 18 months after discharge, it was obviously lower in the 〈 5minutes group than in the 26-50 minutes group （χ^2=14.37, P 〈 0.01）.The incidence rate of headache of all the patients at discharge was different from that at 12 months after discharge （χ^2=6.53 to 5.19, P 〈 0.05）,and the incidence rates of other symptoms had no difference （P 〉 0.05）.The incidence rates of headache and sleep disorder were different between at discharge and 18 months after discharge in the 〈 5 minutes group （P〈 0.01）.CONCLUSION： The posttraumatie amnesia time has close correlation with the type and appearance time of the symptoms of posteoneussional syndrome in patients with concussion of brain, the shorter the posttraumatie amnesia time, the smaller the incidence rate of posteoneussional syndrome at 18 months after discharge. The prolonged time of posteoneussional syndrome at each time period of posttraumatic amnesia is longer, and the symptoms are not ameliorated within half a year.