三种意识量表评估对植物状态患者意识障碍程度的敏感性分析

Sensitivities of 3 different consciousness scales in evaluating the degree of disturbance of consciousness in patients in the vegetative state

目的应用3种临床意识量表评估意识障碍程度,比较各量表间敏感性,为其临床使用提供更好的依据。方法研究对象来自2011年9月-2013年6月中国人民解放军总医院康复中心住院的97例植物状态(VS)患者,应用格拉斯哥昏迷量表(GCS)、改进的昏迷恢复量表(CRS-R)、中国植物状态量表(CVSS)对患者进行评分,以24周或患者脱离最小意识状态(MCS)为评分终点。分析患者由VS转换为MCS时各量表的敏感性及CRS-R量表中各子量表的敏感性。结果各量表敏感性分析显示,CRS-R量表诊断敏感性显著高于GCS和CVSS(分别为:χ~2=29.35,P=0.000;χ~2=44.34,P=0.000),其中又以视觉子量表敏感性最高。各量表总分相关性分析显示CRS-R量表与GCS量表在急性期及慢性期的相关性有统计学意义(P<0.05),与CVSS仅在急性期有一定相关性(P<0.05)。结论 CRS-R量表对患者意识障碍恢复过程中的评估敏感性最高,其中视觉子量表判断MCS较敏感。而对于意识障碍程度严重且没有明显恢复的患者,各量表的判断一致。因此,CRS-R量表可广泛应用于对患者各阶段意识障碍的评估。

Objective To evaluate the degree of disorders of consciousness by 3 different clinical consciousness scales, and to compare the sensitivities of the 3 scales so as to provide better evidence for its clinical utihzation. Methods We selected 97 patients in the vegetative state （VS） from rehabilitation Center, the General Hospital of Chinese PLA from September, 2011 to June, 2013, and all the patients were scored by Glasgow Coma Scale （GCS） , Coma Recovery Scale-Revised （CRS-R） and Chinese Vegetative State Scale （ CVSS） respectively. The assessment finished in 24 weeks or till the time when patients emerged from minimally conscious state （MCS）. The diagnostic sensitivity and the sensitivity of each sub-scale in CRS-R were evaluated when the patients with MCS emerged from VS. Results The sensitivity analysis of the 3 scales showed that the diagnosis sensitivity of CRS-R was significantly higher than those of GCS and CVSS （χ^2 = 29.35, P =- 0.000 ; χ^2= 44.34, P = 0.000）, and the sensitivity of the visual sub-scale was the highest among all the CRS-R sub-scales. The correlation analysis of total scores of the 3 scales showed that the score of CRS-R was significantly correlated with that of GCS in the acute and chronic stages （ P〈0.05 ）, but only correlated with that of CVSS in the acute stage （P〈0.05）. Conclusions The visual sub-scale of CRS-R is a more sensitive tool for detecting MCS during recovery process in the disorders of consciousness. As to the patients with deep unconsciousness and without significant recovery, the 3 scales are in good agreement to determine the degree of disorders of consciousness. It is suggested that CRS-R can be widely used to assess the level of disorders of consciousness in various stages.