急性创伤性脑损伤后早期认知功能障碍特征及影响因素分析

Characteristics and associated factors of early cognitive dysfunction following acute traumatic brain injury

目的 分析急性创伤性脑损伤（TBI）后早期认知功能障碍的特点及影响因素,为早期诊断和干预认知功能障碍提供依据. 方法 前瞻性研究2012年6月-2014年6月收治的轻、中型TBI患者328例.采用简易智能精神状态量表（MMSE）和蒙特利尔认知评估量表（MoCA）评定认知功能,并分为认知功能障碍组和无认知功能障碍组.分析患者在致伤机制、年龄、性别、受教育年限、CT表现类型等方面的差异及引起认知功能障碍的影响因素. 结果 在纳入研究的328例患者中,MMSE评分认知功能障碍患者56例（17.1％）,MoCA评分认知功能障碍患者207例（63.1％）,认知功能障碍主要表现为视空间与执行功能、注意力与计算力、语言、抽象、延迟记忆.认知功能障碍组与无认知功能障碍组在受教育年限、CT表现为蛛网膜下腔出血、挫裂伤、颅内血肿等方面差异均有统计学意义（P＜0.01）.Logistic逐步回归分析显示,受教育年限、脑挫裂伤、颅内血肿是影响TBI认知功能障碍的主要因素（P＜0.01）. 结论 受教育年限、脑挫裂伤和颅内血肿是TBI早期认知功能障碍的主要影响因素.

Objective To analyze the characteristics and associated factors of early cognitive dysfunction following acute traumatic brain injury （TBI） and provide the evidence for early diagnosis and treatment of cognitive dysfunction.Methods A prospective study was performed on 328 patients with mild to moderate TBI from Shanghai Pudong New Area People＆#39;s Hospital since June 2012 to June 2014,using the Mini-mental state examination （MMSE） and Montreal cognitive assessment （MoCA） to assess their cognitive function.Differential analysis of the mechanism of injury,age,gender,years of education,and CT manifestation type was performed in patients with and without cognitive dysfunction.Logistic regression analysis was further used to analyze the risk factors for cognitive dysfunction.Results In enrolled 328 patients,56 patients （17.1%） were identified with cognitive dysfunction in MMSE score,while 207 patients （63.1%） in MoCA score.Cognitive dysfunction mainly manifested as visual-spatial and executive function,attention and calculation ability,language,abstract,and delayed memory.There were significant differences in years of education and CT manifestations （subarachnoid hemorrhage,contusion,intracranial hematoma,etc） between patients with and without cognitive dysfunction （P 〈 0.01）.Logistic regression analysis showed years of education,brain contusion,and intracranial hematoma were the major factor for cognitive dysfunction following TBI （P 〈 0.01）.Conclusion Cognitive dysfunction is largely affected by years of education,brain contusion and intracranial hematoma after TBI.