康复团队在NICU中评估神经重症患者意识障碍的信度研究

The Reliability Study of the Rehabilitation Team Assessing Disorders of Consciousness Among Patients with Severe Neurological Diseases in Neural Intensive Care Unit(NICU)

目的:通过康复团队(康复医师和治疗师)在神经重症监护室(NICU)评估神经重症患者意识障碍的评定者之间信度研究,以推进神经重症意识障碍患者早期康复的开展。方法:2017年9月~2018年5月入住本院NICU65例伴有不同程度意识障碍的神经重症患者。65例患者入住NICU后72h内,由康复医师和治疗师对患者进行一般资料的收集及全面评估,以及使用GCS量表、FOUR量表、CRS-R量表进行评定,每次评定由康复医师和治疗师分别单独进行,记录患者每个评分量表的评分结果及评定时间。结果:65例患者意识障碍类型经康复医师和治疗师分别使用CRS-R量表进行诊断,差异无统计学意义(P>0.05);康复医师和治疗师采用3种量表,评定患者的得分及所用时间,经统计分析,量表得分差异无显著性(P>0.05),所用时间差异有显著性(P<0.05)。结论:康复医师和治疗师的评定结果具有较好的一致性;GCS量表、FOUR量表和CRS-R量表均可作为神经重症患者意识障碍评定的工具。

Objective: The research aimed at assessing the reliability of disorders of consciousness among patients with severe neurological diseases between rehabilitation team and therapist team to promote early rehabilitation for patients with severe neurological diseases suffering from disorders of consciousness. Methods: From September 2017 to March 2018, 65 patients with severe neurological diseases suffering from varying degrees of disorders of consciousness were admitted to NICU of our hospital. Within 72 hrs in NICU, rehabilitation physicians and therapists collected general information and conducted a comprehensive assessment using the GCS scale, FOUR scale and CRS-R scale.The rehabilitation physicians and therapists completed each assessment independently, and recorded the score and assessing time of each rating scale. Results: No statistically significant difference was found in the types of disorders of consciousness among 65 patients diagnosed using CRS-R scale by rehabilitation physicians and therapists. There was no statistically significant difference in patients’ scores using three scales between rehabilitation physicians and therapists(P>0.05).There was statistically significant difference assessing time of three scales between rehabilitation physicians and therapists(P<0.05).Conclusion:There was a good agreement between rehabilitation physicians and the therapists measuring the disorders of consciousness using GCS scale, FOUR scale and CRS-R scale. These three scales could be used as tools for the assessment of the disorders of consciousness among the patients with severe neurological diseases.