慢性意识障碍患者阵发性交感神经过度兴奋综合征的临床分析

A clinical analysis of paroxysmal sympathetic hyperactivity in chronic disorders of consciousness

目的探讨慢性意识障碍患者阵发性交感神经过度兴奋综合征(PSH)的发生率、与意识障碍严重程度的关系以及对意识的影响.方法回顾性分析126例慢性意识障碍患者的临床资料,根据临床特征分为PSH组和对照组,发病后1年进行格拉斯哥结局量表(COS)评分.比较两组患者性别、年龄、损伤机制、格拉斯哥昏迷量表(GCS)评分、修改版昏迷恢复量表(CRS-R)评分、脑电图结果(按照Synek标准分级)、重症监护时间(ICU时间)和GOS评分的差异.结果慢性意识障碍患者PSH的发生率为26.19%(33/126).在随访成功的83例患者中,PSH组26例,对照组57例;PSH组患者年龄(35.19士13.11)岁较对照组(42.86±16.17)岁年轻、GOS评分(1.88±0.99)分较对照组(2.53±1.36)分低、意识恢复的患者(6例,23.08%)较对照组(28例,49.12%)少,差异有统计学意义(P<0.05);两组患者在性别、损伤机制、GCS评分、CRS-R评分、脑电图分级和ICU时间方面的差异无统计学意义(P>0.05).结论PSH是慢性意识障碍患者的常见并发症,其发病年龄相对年轻,PSH的出现会阻碍患者意识恢复.

Objective To investigate the incidence of paroxysmal sympathetic hyperactivity(PSH)in patients with chronic disorders of consciousness,and its relationship with the degree of consciousness disturbance and influence on consciousness.Methods A total of 126 patients with chronic disorders of consciousness were retrospectively reviewed,and divided into PSH group and control group according to clinical characteristics.The Glasgow Outcome Scale(GOS)was evaluated at one year after disease onset.Sex,age,injury mechanisms,Glasgow Coma Scale(GCS)score,Coma Recovery Scale-Revised(CRS-R)score,electroencephalogram results based on Synek's classification,the duration of intensive care unit(ICU)stay,and GOS score were compared between the two groups.Results PSH occurred in 26.19%(33/126)of the patients with chronic disorders of consciousness.Eighty-three patients completed follow-up,with 26 in the PSH group and 57 in the control group.The PSH group had significantly younger age(35.19±13.11 vs 42.86±16.17 years),lower GOS score(1.88±0.99 vs 2.53±1.36),and fewer patients with recovery of consciousness(6 cases,23.08%vs 28 cases,49.12%)compared with the control group(P<0.05).There were no significant differences in sex,injury mechanisms,GCS score,CRS-R score,electroencephalogram grade,and the duration of ICU stay between the two groups(P>0.05).Conclusions PSH is a common complication in patients with chronic disorders of consciousness,with a relatively young age of onset,and can hinder recovery of consciousness.