中重度创伤性颅脑损伤病人认知功能受损特点

Characteristics of cognitive impairment after moderate-to-severe traumatic brain injury

目的评价中重度创伤性颅脑损伤(TBI)病人认知功能受损特点,并分析其与病人总体预后的关系。方法将60例TBI病人分为中度TBI组(n=35)和重度TBI组(n=25),同时收集30例正常人作为对照组(n=30)。采用Mo CA量表评估病人的认知功能,采用GOS量表评估病人的独立生活能力。结果随访3个月时,与对照组比较,中度和重度TBI组病人均有执行和视空间功能、注意力、语言表达、抽象思维、延迟回忆和定向力等认知功能下降(P<0.05)。随访12个月,中度TBI组仅较对照组存在执行和视空间及延迟回忆功能的下降,其注意力、语言表达、抽象思维、延迟回忆功能和定向力较3个月时得到明显改善(P<0.05);而重度TBI组较对照组还存在注意力、语言表达和抽象思维等功能下降,其执行和视空间功能、注意力和定向力也较3个月得到明显改善(P<0.05)。在Pearson偏相关分析中,仅执行和视空间功能与GOS成正相关(r=0.518,P<0.001)。结论中度和重度TBI病人在认知功能障碍及预后方面存在差异,认知功能水平可能影响病人的独立生活能力。

Objectives To assess characteristics of cognitive impairment of patients after moderate-to-severe traumatic brain injury（TBI）, and their relationships with global outcome. Methods Sixty patients were divided into moderate TBI group（n = 35） and severe TBI group（n = 25）. And 30 healthy volunteers served as control group. Cognitive function and global outcome were evaluated with Mo CA and GOS, respectively. Results Compare with control group, executive and visuospatial function, attention, language expression, abstract thinking, delayed memory and orientation were reduced 3 months after TBI in patients with moderate or severe TBI（ P〈0. 05）. The attention, language expression, abstract thinking, delayed memory and orientation were improved more significantly than 3 months and accompanied with only reduced executive and visuospatial function, and delayed memory 12 month after TBI in the patients with moderate TBI（ P〈0.05）. The executive and visuospatial functions, attention and orientation were improved more significantly than 3 months, but also had reduced attention, language expression and abstract thinking in the patients with severe TBI（P〈0.05）. Pearson partial correlation coefficient analysis showed that executive and visuospatial functions were positively correlated with GOS（ r = 0.518, P〈0.001）. Conclusions There are differences in patterns of cognitive deficits and prognoses between moderate and severe TBI patients, and cognitive function may affect the independent living skills.