创伤性脑损伤患者认知功能影响因素分析

Analysis of factors affecting cognitive function in patients with traumatic brain injury

目的分析中重度创伤性脑损伤(traumatic brain injury,TBI)患者认知功能的重要影响因素。方法回顾性选取2012年1月1日至2018年12月31日于南通大学附属医院康复医学科住院的113例中重度TBI患者的临床资料,以简易精神状态检查(mini-mental state examination,MMSE)结果作为患者出院时认知功能的评定指标,分析影响中重度TBI患者认知功能的相关因素。结果113例患者的年龄为(52.42±14.20)岁,其中男性84例,女性29例,因交通事故而受伤者占64.6%。单因素分析中,年龄、高血压病史、入院格拉斯哥昏迷评分(Glasgow coma scale,GCS)、入院瞳孔对光反射异常、气管切开、昏迷天数、高压氧治疗和住院期间并发脑积水共8个变量与患者出院MMSE有关,差异有统计学意义(P<0.05)。多因素分析中,入院GCS、高压氧治疗、昏迷天数和年龄是影响患者出院MMSE的独立因素,差异有统计学意义(P<0.05)。结论入院GCS、昏迷天数、年龄可用于独立判断中重度TBI患者的认知功能,住院期间并发脑积水、高血压病史、入院瞳孔对光反射异常和气管切开可用于综合判断认知功能;高压氧治疗可以改善认知功能。

Objective To analyze the key influencing factors of cognitive function of patients with moderate and severe traumatic brain injury(TBI).Methods The clinical data of 113 patients with moderate and severe TBI admitted to the Department of Rehabilitation Medicine of the Affiliated Hospital of Nantong University from January 1st,2012 to December 31st,2018 were retrospectively reviewed to analyze the factors affecting cognitive function in patients with moderate and severe TBI by using the Mini-Mental State Examination(MMSE)to evaluate the cognitive function of patients at discharge.Results The average age of 113 patients was 52.42±14.20 years old,among whom 74.34%were male and 64.6%of the male patients were injured due to traffic accidents.In the univariate analysis,a total of 8 variables related with MMSE at discharge,including age,history of hypertension,Glasgow coma scale(GCS)at admission,abnormal pupillary reflex at admission,tracheotomy,days of coma,hyperbaric oxygen therapy,and hydrocephalus during hospitalization,with statistically significant differences(P<0.05).Multivariate analysis showed that GCS score at admission,hyperbaric oxygen therapy,days of coma,and age were the independent factors affecting MMSE at discharge,and the differences were statistically significant(P<0.05).Conclusion GCS score at admission,days of coma,and age can be adopted independently to determine the cognitive function of patients with moderate and severe TBI.Hydrocephalus during hospitalization,history of hypertension,abnormal pupillary reflex at admission,and tracheotomy can be used synthetically to determine the cognitive function.Hyperbaric oxygen therapy can improve the cognitive function.