脑外伤患者认知功能障碍的危险因素

Risk factors for cognitive dysfunction in patients with traumatic brain injury

目的探讨脑外伤患者发生认知功能障碍的危险因素。方法2021年3月至9月多中心选取住院治疗的556例脑外伤患者,采用性别1∶1匹配的病例-对照研究设计,经蒙特利尔认知评估量表(MOCA)评定,将有认知障碍者作为病例组,无认知障碍者作为对照组,收集一般资料和疾病资料,并采用社会支持评定量表、医院焦虑抑郁量表进行评估。结果Logistic回归分析结果显示,大专及以上文化水平(OR=0.040)、高水平社会支持(OR=0.118)是脑外伤患者认知障碍的保护因素(P<0.05);年龄60~88岁(OR=9.996)、重度脑损伤(OR=7.345)、外伤后头痛(OR=2.159)、夜间易醒或多梦次数≥3次/周(OR=3.705)、脑损伤导致上肢功能严重障碍(OR=6.072)、抑郁(OR=5.202)是脑外伤患者认知障碍的危险因素(P<0.05)。结论脑外伤患者发生认知障碍的相关因素涵盖一般因素、疾病因素、睡眠、心理及社会支持等多元因素。提示临床除疾病治疗外,需要改善睡眠、调整心理、增加支持,以降低患者认知障碍率,促进疾病康复。

Objective To investigate the risk factors of cognitive dysfunction in patients with traumatic brain injury.Methods From March to September,2021,556 hospitalized patients with traumatic brain injury were selected from a multicenter study.A 1∶1 sex-matched case-control study design was used.After assessment by Montreal Cognitive Assessment(MoCA),those with cognitive impairment were as case group and those without cognitive impairment were as control group.They were collected general data and assessed with Social Support Rating Scale(SSRS)and Hospital Anxiety and Depression Scale(HADS).Results Logistic regression analysis showed that college education or above(OR=0.040)and high level of social support(OR=0.118)were protective factors for cognitive impairment(P<0.05).Aged 60 to 88 years(OR=9.996),severe brain injury(OR=7.345),headache after injury(OR=2.159),frequent waking at night or multiple dreams≥three times per week(OR=3.705),severe upper limb dysfunction caused by brain injury(OR=6.072),depression(OR=5.202)were risk factors for cognitive impairment(P<0.05).Conclusion The related factors for cognitive impairment in patients with traumatic brain injury include general factors,disease factors,sleep,psychological and social support and other factors.It is suggested that in addition to the treatment of disease,it is necessary to improve sleep,psychology and social support,to reduce the incidence of cognitive impairment and promote the recovery of disease.