创伤性脑损伤预后评估的争议与进展

Controversy and progress of prognostic evaluation of patients with traumatic brain injury

创伤性脑损伤(TBI)是世界卫生领域严重的全球性问题。因其居高不下的致死、致残率,导致患者遭受到包括身体、精神、情感和认知功能障碍等在内的多重损害,并给个人、家庭及社会带来沉重的负担。因此评估患者的预后对于评价患者的长期损害和病情恢复、预测患者和家属的医疗需求、比较多个医学中心的治疗结果、评估常规治疗和新方法的有效性及临床治疗效果都显得十分必要。TBI因致伤因子、损伤机制、临床表现的差异性、个体异质性等诸多因素的影响而使其预后呈现出复杂性和多样性。TBI评估领域涉及包括整体预后、意识恢复、生理功能、认知水平、精神状态、生活质量等在内的多个方面。但越来越多的研究发现,任何单一的指标不足以显示临床工作中的治疗效果,并使全面、多维的评估充满挑战。所以,在TBI预后转归评估方面采取整体的多层面标准化的多维预后评估极具挑战性。在TBI预后预测方面,将早期的损伤严重程度、受伤的机制、病理解剖的特征与TBI的多种预后因素、预测因子结合起来,建立出良好的动态的预后预测模型则显得尤为重要。这二者均是TBI预后评估领域的未来发展方向。本文通过对目前TBI预后评估领域较为常用的转归评估工具和预测工具进行了例举,并分别介绍了这些方法的运用价值。同时对当前TBI预后评估领域的发展及不足进行了讨论,进而对未来此领域的研究发展方向提出了展望。

Traumatic brain injury(TBI)is a global health problem that has high mortality and morbidity and contributes to physical,mental,and cognition disorders,leading to heavy personal,family,and social burdens.Therefore,the prognostic evaluation of TBI patients is essential for assessing TBI patients'long-term injury and recovery,predicting the medical request of the patients and families,comparing analysis reports among medical centers,and evaluating the clinical effectiveness of routine and novel treatments.The prognosis of TBI is complex and variable due to differences in injury factors,injury mechanisms,and clinical symptoms,as well as individual heterogeneity.The evaluations of TBI includes outcomes,consciousness,physiological function,cognition,mental state,and quality of life.Many studies have suggested that a single indicator could not be enough to evaluate the clinical outcomes and clinical effect.And it is a big challenge to evaluate the prognosis of TBI through multi-step standardization and different dimensions analyses.The combination of early injury severity,injury mechanism,and pathological characteristic with the prognostic and predictive factors for TBI might bring up a good clinical dynamic model for prognosis prediction,which might be a direction to evaluate TBI in the future.This review addresses the outcome assessment of TBI using prognostic and predictive evaluation tools and discusses their applications.We also discuss the development of prognostic evaluation of TBI and the related shortcomings,and offer a new perspective for this area.