重型创伤性颅脑损伤后认知功能障碍特征及其影响因素的初步研究

The preliminary research on the characteristics of cognitive function and its related factors inpatients with severe traumatic brain injury

目的通过分析重型创伤性颅脑损伤（STBI）患者治愈出院3个月后的认知功能特征，初步探讨其与影响因素的关系。方法运用简易智能精神状态检查量表（MMSE）、蒙特利尔认知评估量表中文版（MoCA）及第2版洛文斯顿作业疗法认知评定量表（LOTCA）对21例行开颅血肿和（或）挫裂伤灶清除加单侧标准大骨瓣减压术的STBI患者（创伤组）和30例健康体检者（对照组）的认知功能予以评定；以多元逐步回归法分析并评定结果与各影响因素之间的关系。结果创伤组患者治愈出院3个月后各项认知功能测试评分均显著低于对照组，左侧半球损伤患者的注意与计算、语言重复与流畅性、逻辑思维、注意集中力、延迟回忆能力、抽象能力评分显著下降，右侧半球损伤患者的视空间与钟表试验、空间知觉、视运动组织评分显著下降；多元逐步回归分析表明，年龄（r=-0．722，P〈0．01）、损伤部位（r=0．607，P〈0．01）及受教育程度（r=0．733，P〈0．01）对整体认知功能影响有统计学意义。结论sTBI后认知功能障碍与年龄、损伤部位及受教育程度密切相关。

Objective To investigate the characteristics of cognitive function in patients who suffered from severe traumatic brain injury- （sTBI） at 3 months after treatment,and study the relationship between the characteristics and its related factors. Methods Montreal cognitive assessment （MoCA）, Loewenstein occupational therapy cognitive assessment （LOTCA）,mini-mental state examination （MMSE） scales were used to evaluate cognitive function in 30 normal individuals （control group ） and in 21 patients who suffered from unilateral decompression eraniectomy and hematoma and （or） contusion foci removed for decompression （sTBI group）. The relationship between the results and its related factors was analyzed by multivariate statistical methods. Results All the scores of cognitive function as, sessment at 3 months after curing in sTBI group were significantly lower than those in control group,the ability of computing,repetition and fluency of language,logical thinking,attention,delayed memories,abstraction in patients with left hemisphere injury were significantly lower, while the ability of visuospatial and watch test, spatial perception, organization in patients with right hemisphere injury were significantly lower. Multivariate statistics showed that age（ r = -0.722 ,P 〈 0.01 ）, injury parts（r = 0.607, P 〈 0.01 ）, and the level of education （r =0.733,P 〈 0.01 ） had significant impact on the overall cognitive function. Conclusion Cognitive dysfunction after sTBI is closely related with age, injury parts and the level of education.