Crit Care Med:研究者发现创伤性脑损伤恢复的新预测因素

2016-09-17 Mechront 译 MedSci原创

在预测创伤性脑损伤恢复方面,外伤性遗忘症比最初的格拉斯哥昏迷评分更优,但是需要花费更长时间来评估(几天或几周)。 我们在一级创伤ICU进行了两阶段队列研究,旨在探究,视觉固定(入住ICU 24小时内更高认知功能的标志物)的恢复能否作为创伤性脑损伤恢复的早期指标。 研究纳入了2010年至2013年的中度至重型颅脑损伤患者。对181例失去固定能力的患者进行了视觉固定评估(通过标准化

在预测创伤性脑损伤恢复方面,外伤性遗忘症比最初的格拉斯哥昏迷评分更优,但是需要花费更长时间来评估(几天或几周)。

我们在一级创伤ICU进行了两阶段队列研究,旨在探究,视觉固定(入住ICU 24小时内更高认知功能的标志物)的恢复能否作为创伤性脑损伤恢复的早期指标。

研究纳入了2010年至2013年的中度至重型颅脑损伤患者。对181例失去固定能力的患者进行了视觉固定评估(通过标准化行为进行评估)(阶段1)。与外伤性遗忘症持续时间和最初的格拉斯哥昏迷评分进行预测“格拉斯哥结果量表扩展评分 ”性能的比较(n = 144; 2A阶段)。亚组完成视觉注意任务(n = 35; 2B阶段),以及在创伤性脑损伤后,行大脑MRI(n = 23; 2C阶段)。

当视觉固定的AUC为0.85时,入住ICU 24小时,有或没有视觉固定对格拉斯哥结果量表扩展评分的预测性能和外伤性遗忘症相当(AUC 0.81;相差0.04; p = 0.28),但是最初的格拉斯哥昏迷量表评分就不行(AUC  0.63)。

校正年龄、功能、CT扫描结果后,视觉固定仍是格拉斯哥结果量表扩展评分的预测因素(β, -0.29; p < 0.05)。入住ICU 24小时,视觉不固定 vs 视觉固定患者,注意力更差,脑容量赤字区域更大。

结果表明,视觉固定能作为创伤性脑损伤恢复的早期指标。

原始出处:


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    2017-04-24 stfoxst
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    2016-09-20 amyloid
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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129329, encodeId=ad41129329bf, content=好好学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sat Sep 17 11:31:00 CST 2016, time=2016-09-17, status=1, ipAttribution=)]
    2016-09-27 童小孩

    学习了,很受益,谢谢分享,继续关注中!

    0

  4. 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  5. 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  6. 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  7. 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CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129930, encodeId=0ac3129930c2, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Sun Sep 18 08:14:00 CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129787, encodeId=4fc0129e8705, content=很好的内容,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ceb079804, createdName=lhl629, createdTime=Sat Sep 17 22:41:00 CST 2016, time=2016-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129329, encodeId=ad41129329bf, content=好好学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sat Sep 17 11:31:00 CST 2016, time=2016-09-17, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=2032740, encodeId=dc222032e400c, content=<a href='/topic/show?id=ff85e343730' target=_blank style='color:#2F92EE;'>#研究者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73437, encryptionId=ff85e343730, topicName=研究者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1a19115, createdName=stfoxst, createdTime=Mon Apr 24 12:44:00 CST 2017, time=2017-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2025433, encodeId=7b8b202543371, content=<a href='/topic/show?id=66f93204223' target=_blank style='color:#2F92EE;'>#创伤性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32042, encryptionId=66f93204223, topicName=创伤性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=325a197, 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CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129930, encodeId=0ac3129930c2, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Sun Sep 18 08:14:00 CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129787, encodeId=4fc0129e8705, content=很好的内容,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ceb079804, createdName=lhl629, createdTime=Sat Sep 17 22:41:00 CST 2016, time=2016-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129329, encodeId=ad41129329bf, content=好好学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sat Sep 17 11:31:00 CST 2016, time=2016-09-17, status=1, ipAttribution=)]
    2016-09-18 1dd8a7c5m95(暂无匿称)

    学习了,赞一个!!!

    0

  9. 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channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Sun Sep 18 23:44:00 CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1607106, encodeId=d30a160e1068d, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Sun Sep 18 23:44:00 CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129930, encodeId=0ac3129930c2, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Sun Sep 18 08:14:00 CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129787, encodeId=4fc0129e8705, content=很好的内容,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ceb079804, createdName=lhl629, createdTime=Sat Sep 17 22:41:00 CST 2016, time=2016-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129329, encodeId=ad41129329bf, content=好好学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sat Sep 17 11:31:00 CST 2016, time=2016-09-17, status=1, ipAttribution=)]
    2016-09-17 lhl629

    很好的内容,谢谢分享。

    0

  10. 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CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129930, encodeId=0ac3129930c2, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Sun Sep 18 08:14:00 CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129787, encodeId=4fc0129e8705, content=很好的内容,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ceb079804, createdName=lhl629, createdTime=Sat Sep 17 22:41:00 CST 2016, time=2016-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129329, encodeId=ad41129329bf, content=好好学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sat Sep 17 11:31:00 CST 2016, time=2016-09-17, status=1, ipAttribution=)]
    2016-09-17 忠诚向上

    好好学习一下

    0

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2016年8月,美国物理治疗协会(APTA)神经物理治疗分会TBIEDGE工作组发布了中度到重度创伤性脑损伤患者结局评价建议,该工作组建议为临床医生,研究人员以及教育工作组选择结局评价措施提供指导。全文获取:下载地址:指南下载 (需要扣积分2分, 梅斯医学APP免积分下载)

Neurology:创伤性脑损伤的人注意啦,睡眠觉醒障碍可能正在悄无声息的困扰你

根据2016年4月27日在线发表在美国科学院医学杂志Neurology®的一篇研究,有过创伤性脑损伤(TBI)的人可能在受伤后的一年半有睡眠问题。此外,TBI患者也可能并不知道自己的睡眠到底被影响了多少。在美国每年有170万人经历TBI,且有证据表明,TBI的患病率在全球范围内不断攀升。“这是迄今为止研究关于睡眠质量和TBI的最长的前瞻性和最全面研究,”该研究的作者,瑞士苏黎世大学医院,医学博士L

NEJM:低温治疗对TBI后颅内高压患者功能预后的影响

对于创伤性脑损伤患者低温治疗可以减少颅内高压,但低温治疗是否能改善功能预后尚不清楚。研究人员将通过第一阶段治疗扔存在颅内压超过20毫米汞柱的创伤性脑损伤(TBI)患者随机分配成两组,标准治疗(对照组)和低温治疗(32-35C)+标准治疗。在对照组中,通过第二阶段治疗(如渗透疗法)以控制颅内压。在低温治疗+标准治疗组中如果低温治疗不能控制颅内压时加用第二阶段治疗。在两组中,如果第二阶段的治疗不能控制

NEJM:低温联合标准治疗并不能更好的改善颅脑创伤患者的脑功能

对于颅脑损伤的患者,低温可降低其颅内高压。但是低温对大脑功能性的影响尚未清楚。

PLOS Med:儿童期创伤性脑损伤会导致长期的健康问题

近期有数据显示,儿童期创伤性脑损伤与长期的健康问题具有潜联系。研究人员进一步得出结论,应该对儿童和青少年制定年龄特异性的临床指导方针和预防策略。 来自牛津大学的Amir Sariaslan博士和同事们对1985-1973年之间的1143470名参与者(来自瑞典出生队列)进行了研究,探究儿童期创伤性脑损伤、成人死亡率、精神病发病率和社会结果之间的关联。最终研究者纳入了104290名在≤25岁时

Neurology:创伤性脑损伤发生18月后,患者依旧存在睡眠问题!

目的本研究为前瞻性对照临床试验和生理学研究,主要研究内容是创伤性脑损伤后患者出现的慢性睡眠紊乱。 方法研究人员选取了140名首次发生急性创伤性脑损伤的患者,严重程度各有不同,其中包括60例前瞻性随访调查。患者若在出现脑损伤之前还患有其他神经或系统性疾病、出现药物滥用史及精神疾病则不参与研究。创伤18个月后,研究人员对31个参与者的睡眠状况进行了详细的评估。对照组民众为年龄、性别、睡眠连续的健康民众