摘要
目的评估恢复期中重度脑损伤后阵发性交感神经兴奋综合征(PSH)患者的临床结局。方法回顾性分析2018年3月至2023年3月期间在首都医科大学附属复兴医院康复中心住院治疗的中重度脑损伤患者的临床资料。根据是否出现PSH发作将其分为PSH组和非PSH组, 再将PSH组与非PSH组患者以1∶1的比例进行倾向性评分匹配。分析匹配前及匹配后队列患者的基线特征及匹配后队列患者的临床结局。结果共有580例中重度脑损伤患者入选, 其中75例患者出现PSH发作并被纳入PSH组, 余患者纳入非PSH组。匹配前2组患者年龄、房颤、高血压、胸部外伤、格拉斯哥昏迷量表(GCS)评分、气管切开、脑积水、入院时心率、呼吸频率、肌张力、关节活动受限情况组间差异均具有统计学意义(P<0.05)。按1∶1比例进行倾向性评分匹配后, PSH组与非PSH组各有患者67例, 匹配后2组患者入院时心率、呼吸频率、肌张力、关节活动受限情况组间差异均具有统计学意义(P<0.05);与非PSH组比较, PSH组患者出院时GCS评分、格拉斯哥结局量表(GOS)评分均明显降低(P<0.05), 残疾等级量表(DRS)评分则显著增加(P<0.05)。与同时间点非PSH组比较, 出院时PSH组患者GOS评分降低了0.47分(CI:0.41~0.56, P<0.001);出院3个月后PSH组患者GOS评分降低了0.55分(CI:0.48~0.61, P<0.001);出院6个月后PSH组患者GOS评分降低了0.75分(CI:0.66~0.82, P<0.001);出院12个月后PSH组患者GOS评分降低了0.87分(CI:0.77~0.97, P<0.001)。结论 PSH能影响中重度脑损伤患者的意识恢复及日常生活活动能力, 且PSH患者的预后相对较差。
Objective To evaluate the clinical outcomes of patients with paroxysmal sympathetic hyper-activity(PSH)after moderate to severe brain injury.Methods Clinical data describing 580 patients of the Rehabilitation Center of Fuxing Hospital with moderate to severe brain injury were analyzed retrospectively.They were divided into a PSH group and a non-PSH group depending on whether PSH attacks occurred.Propensity score matching was performed to create a 1:1 ratio between the two groups.The patients'baseline characteris-tics were analyzed before the matching and with the matched cohorts,and the clinical outcomes of the patients in the matched cohorts were compared.Results Seventy-five of the patients experienced PSH attacks and were included in the PSH group,while the others formed the non-PSH group.Before matching,the two groups had significant differences in age,atrial fibrillation,hypertension,chest trauma,Glasgow Coma Scale(GCS)score,tracheotomy,hydrocephalus,heart rate at admission,respiration rate,muscle tone,and limited joint ac-tivity.After the propensity score matching,67 patients were included in the PSH and non-PSH groups.The differences in heart rate,respiration rate,muscle tone,and limited joint activity between the two groups at ad-mission were then statistically significant.However,unlike the non-PSH group,the PSH group showed a signifi-cant decrease in its average GCS score and Glasgow Outcome Scale(COS)score at discharge,as well as a sig-nificant increase in its average Disability Rating Scale score.Compared with the non-PSH group at the same timepoint,the GOS score of the PSH group had decreased by 0.47 at discharge(CI:0.41-0.56).Then,three months after discharge the average COS score of the PSH group had decreased by 0.55(CI:0.48-0.61).By six months that was 0.75(CI:0.66-0.82)and by twelve months 0.87(Cl:0.77-0.97).Conclusions PSH can affect the consciousness of patients with moderate to severe brain injury and their ability in the activities of daily life.The prognosis of PSH patients is relatively poor.
作者
刘素娟
王泳
李冉
宋璐
李海
东刘洁
Liu Sujuan;Wang Yong;Li Ran;Song Lu;Li Haidong;Liu Jie(Rehabilitation Center of Fuxing Hospital,Capital Medical University,Beijing 100038,China)
出处
《中华物理医学与康复杂志》
北大核心
2025年第7期608-613,共6页
Chinese Journal of Physical Medicine and Rehabilitation
基金
首都卫生发展专项基金资助项目(首发2022-4-7022)
西城区卫生健康委员会2024年度科技新星项目(XWKX2024-30)。
关键词
阵发性交感神经兴奋综合征
康复
脑损伤
预后
Paroxysmal sympathetic hyperactivity
Hyperactivity
Brain injury
Prognosis
