【摘要】：目的探討腦損傷后意識障礙患者意識恢復的影響因素。方法回顧性分析114例腦損傷后意識障礙患者臨床資料,采用二元Logistic回歸法對可能影響意識恢復的因素進行分析并建立回歸模型,繪制ROC曲線,確定預后模型的最佳臨界值。結果單因素分析結果顯示植物狀態(tài)持續(xù)時間(P0.001)、入院時昏迷恢復量表(CRS-R)評分(P0.001)、腦積水(P=0.037)、肌張力高(P=0.034)、中樞性發(fā)熱(P=0.035)、陣發(fā)性交感神經過度興奮(P=0.004)與意識恢復相關。Logistic回歸分析顯示中樞性發(fā)熱(OR=3.493,P=0.044)、植物狀態(tài)持續(xù)時間(OR=1.016,P=0.008)、陣發(fā)性交感神經過度興奮(OR=4.223,P=0.034)及入院時CRS-R評分(OR=0.640,P=0.002)是意識恢復的獨立影響因素。該模型Hosmer-Lemeshow檢驗的χ~2值為10.214(P=0.250),預測概率ROC曲線下面積為0.91,提示該模型擬合優(yōu)度很好。結論陣發(fā)性交感神經過度興奮的出現是影響意識障礙患者意識恢復的首要因素;中樞性發(fā)熱的出現,入院時CRS-R評分較差,植物狀態(tài)持續(xù)時間過長是影響意識恢復的次要因素。
[Abstract]:Objective to explore the influencing factors of consciousness recovery in patients with consciousness disorder after brain injury. Methods the clinical data of 114 patients with consciousness disorder after brain injury were retrospectively analyzed. The factors that might affect the recovery of consciousness were analyzed by binary Logistic regression method and the regression model was established. The ROC curve was drawn to determine the optimal critical value of the prognosis model. Results univariate analysis showed that the duration of vegetative state (P0.001), coma recovery scale (CRS-R) on admission (P0.001), hydrocephalus (P0. 037), muscular tension (P0. 034), central fever (P0. 035) were observed. Paroxysmal sympathetic hyperexcitation (P0. 0004) was associated with recovery of consciousness. Logistic regression analysis showed central fever (OR=3.493,P=0.044) and vegetative state duration (OR=1.016,P=0.008). Paroxysmal sympathetic hyperexcitation (OR=4.223,P=0.034) and CRS-R score (OR=0.640,P=0.002) on admission were independent factors influencing the recovery of consciousness. The 蠂 ~ 2 value of the Hosmer-Lemeshow test of the model is 10.214 (P = 0.250) and the area under the prediction probability ROC curve is 0.91, which indicates that the model has a good fit degree. Conclusion the occurrence of paroxysmal sympathetic hyperexcitation is the primary factor affecting the recovery of consciousness in patients with consciousness disorder. The occurrence of central fever, the poor CRS-R score on admission, and the long duration of vegetative state were the secondary factors affecting the recovery of consciousness.
【作者單位】： 廣州中醫(yī)藥大學;廣州總醫(yī)院神經康復一科;
【基金】：國家自然科學基金(81371535)
【分類號】：R651.15

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