JAMA子刊:短期内的严重损伤不代表中度至重度颅脑创伤预后不良

2021-07-24 MedSci原创 MedSci原创

颅脑外伤是世界瞩目的公共卫生问题

颅脑外伤是世界瞩目的公共卫生问题,而中国颅脑创伤年发生率为55-64/10万,每年导致近10万人死亡,数十万伤残,是严重的公共卫生问题。大数据显示:2011年中国酒驾入刑以来,汽车导致的颅脑创伤有所减少。但是,电动车导致的颅脑创伤发生数明显增加。

随着中国大多数医院CT扫描的普及、神经外科重症监护病房的建立、颅内压监测技术、手术技术及脑保护技术的进展、循证医学临床研究的开展、中国专家共识和指南的编写等等,我国颅脑创伤救治水平显著提高,总体水平居国际前列。

6月1日起,全国逐渐实行“头盔法”。强制带头盔的主要原因是,避免头部受伤,降低意外事故风险。头部受伤后,会造成许多不良后果,不仅会让人“变傻”,可能还会带来许多“后遗症”。

比如在美国,有超过2300万名40岁以上的成年人,曾报告有头部受伤并丧失意识。2006年至2014年间,头部损伤急诊就诊率增加了54%,而头部损伤相关死亡率在此期间下降了6%,这表明由于人们对头部损伤的认识提高和存活率的改善,头部损伤的幸存者比以往任何时候都多。

然而,很少有研究能够对中度至重度脑外伤(msTBI)后的急性到慢性恢复阶段进行前瞻性、纵向的结果数据收集。为了前瞻性地评估MSTBI后2周、3、6和12个月的主要功能恢复的结果,来自美国麻省总院等几个机构的专家联合开展了相关研究,结果发表在JAMA neurology杂志上。

这项队列研究是TRACK-TBI的一部分,于2014年2月至2018年8月在美国18个一级创伤中心进行,随访至伤后12个月。参与者为msTBI患者(Glasgow评分3-12分)。GOSE和DRS被用来评估伤后2周、3、6和12个月的整体功能状况。GOSE的分数被二分为有利的(4-8分)和不利的(1-3分)。

结果显示, TRACK-TBI研究中的2679人中共有484名符合条件的患者被纳入。其中,重度TBI(n=362;283名男性[78.2%];中位年龄,35.5[25-53]岁)和中度TBI(n=122;98名男性[80.3%];中位年龄,38[25-53]岁)具有可比性。

随访期间患者的神志与精神恢复情况

在受伤后2周,290名严重创伤性疾病参与者中的36人(12.4%)和93名中度创伤性疾病参与者中的38人(41%)有良好的结果(GOSE评分4-8);严重创伤性疾病组322人中的301人(93.5%)和中度创伤性疾病组103人中的81人(78.6%)在DRS上有中度残疾或更差(总评分≥4)。

到受伤后12个月,271名重度TBI患者中的142人(52.4%)和72名中度TBI患者中的54人(75%)取得了良好的结果。近1/5的重度TBI患者(270人中的52人[19.3%])和1/3的中度TBI患者(71人中的23人[32%])在12个月时没有残疾(DRS得分0)。

随访期间患者睡眠情况改善

同时,在2周时处于植物状态的参与者中,79人中有62人(78%)恢复了意识,56人中有14人(25%)在12个月前恢复了方向感。

综上,MSTBI患者在受伤后2周至12个月内往往有重大的功能改善。短期内的严重损伤并不预示着相当数量的MSTBI患者会出现不良后果。

 

参考文献:

Functional Outcomes Over the First Year After Moderate to Severe Traumatic Brain Injury in the Prospective, Longitudinal TRACK-TBI Study. JAMA Neurol. Published online July 06, 2021. doi:10.1001/jamaneurol.2021.2043

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    2021-07-24 @gxl

    非常受用

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1796931, encodeId=eab91e969318e, content=<a href='/topic/show?id=bf162214668' target=_blank style='color:#2F92EE;'>#中度至重度#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22146, encryptionId=bf162214668, topicName=中度至重度)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=de89102, createdName=liuyong2980, createdTime=Sun May 15 11:08:17 CST 2022, time=2022-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1335362, encodeId=59bb133536289, content=<a href='/topic/show?id=e7cc32022c7' target=_blank style='color:#2F92EE;'>#创伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32022, encryptionId=e7cc32022c7, topicName=创伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=aa5a2500103, createdName=ms920641618706883, createdTime=Mon Jul 26 06:08:17 CST 2021, time=2021-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1368909, encodeId=d23413689094e, content=<a href='/topic/show?id=0f9010046117' target=_blank style='color:#2F92EE;'>#颅脑创伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100461, encryptionId=0f9010046117, topicName=颅脑创伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f378286, createdName=shalley66, createdTime=Mon Jul 26 06:08:17 CST 2021, time=2021-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1398171, encodeId=640713981e1a6, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, 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=Mon Jul 26 06:08:17 CST 2021, time=2021-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1488387, encodeId=f21f148838ef4, content=<a href='/topic/show?id=b34f1001e187' target=_blank style='color:#2F92EE;'>#预后不良#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100171, encryptionId=b34f1001e187, topicName=预后不良)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b86b8414062, createdName=caoliehu, createdTime=Mon Jul 26 06:08:17 CST 2021, time=2021-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1002350, encodeId=1c63100235005, content=非常受用, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210724/725901dc0ed249ebba9d096aacddde3f/a89b874e17434adb82b0c2dff5f374f1.jpg, createdBy=c0225555986, createdName=@gxl, createdTime=Sat Jul 24 19:21:55 CST 2021, time=2021-07-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036764, encodeId=40561036e6468, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sat Jul 24 18:08:17 CST 2021, time=2021-07-24, status=1, ipAttribution=)]
    2021-07-24 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

拓展阅读

ACTA NEUROPATHOLOGICA:接触运动的危险——弥漫性脑肿胀和慢性创伤性脑病的神经病理研究

接触性运动的年轻运动员的尸检研究报告慢性创伤性脑病神经病理变化(CTE-NC),为早期生活中活跃的接触性运动参与者提供了神经退行性病理的证据,加强了运动相关RHI和脑外伤暴露的关注。

Neurology:慢性创伤性脑损伤的淀粉样蛋白和 Tau 成像: 一个横向研究

创伤性脑损伤(tBI)已被认为是阿尔茨海默病的一个危险因素。与健康对照组相比,单一的中度至重度 TBI 与慢性期 β-淀粉样蛋白或 tau 病变的负担较高无关。

Alzheimer&Dementia:正名!创伤性脑损伤和PTSD与阿尔茨海默病病理无关

TBI和/或PTSD与AD生物标志物的升高没有关系。暴露的退伍军人较差的认知状态可能是由于其他合并的病症。

Brain: 脑创伤后8个月的胶质纤维酸性蛋白和神经丝蛋白轻链水平可预测5年后脑结构改变

后期的血液生物标志物水平可用于识别具有进行性神经损伤高风险的创伤性脑损伤幸存者。

CELL:tau蛋白乙酰化连接创伤性脑损伤和阿尔兹海默症

在有TBI史的AD患者中,其脑中乙酰化tau蛋白的增加会进一步增强,接受p300/CBP抑制剂salsalate或diflunisal的患者则表现出AD和临床诊断TBI的发生率降低。

World J Surg:闭合性创伤性脑损伤后,β受体阻滞剂对生存率的影响

背景:许多北美研究显示,创伤性脑损伤后(TBI),应用β阻滞剂能提高患者生存率。这篇研究的主要目的就是评估瑞典的一组严重的闭合性TBI患者,应用β阻滞剂对其死亡率的影响。方法:收集了从2007年1月到2011年12月间,一个城市学院创伤中心中,严重的TBI患者的登记记录。严重的闭合性TBI定义为,AIS分数≥3的颅内损伤,并且排除颅外损伤。应用多变量logictic回归分析应用β阻滞剂对死亡率的影