脑干出血患者基本生命体征与意识障碍行为学评分的相关性分析

左诗怡; 孙娟; 陈珍珍; 蔡涵旭; 胡志安; 姚忠祥; 刘勇

doi:10.16016/j.1000-5404.202102092

您当前的位置：

首页 >

文章列表页 >

脑干出血患者基本生命体征与意识障碍行为学评分的相关性分析

专题报道：意识障碍的基础与临床研究 | 更新时间：2026-01-09

- 脑干出血患者基本生命体征与意识障碍行为学评分的相关性分析
- Correlation analysis of basic vital signs and behavioral score of disorders of consciousness in patients with brainstem hemorrhage
- 第三军医大学学报 2021年43卷第15期页码：1418-1423
- 作者机构：
  
  1.400037 重庆，陆军军医大学(第三军医大学)第二附属医院疼痛与康复医学科
  2.400038 重庆，陆军军医大学(第三军医大学)基础医学院生理学教研室，脑与智能研究院
- 作者简介：
  
  [姚忠祥，E-mail: yaozhx@yahoo.com YAO Zhongxiang, E-mail: yaozhx@yahoo.com
  [刘勇，E-mail: lzsht@aliyun.com LIU Yong, E-mail: lzsht@aliyun.com
- 基金信息：
  
  国家自然科学基金创新研究群体项目(31921003)
- DOI：10.16016/j.1000-5404.202102092
  中图分类号： R741.04;R743.34;R749.13
- 收稿：2021-02-20，
  
  修回：2021-06-04，
  
  纸质出版：2021-08-15
- 稿件说明：
移动端阅览
左诗怡, 孙娟, 陈珍珍, 等. 脑干出血患者基本生命体征与意识障碍行为学评分的相关性分析[J]. 第三军医大学学报, 2021,43(15):1418-1423.

Shiyi ZUO, Juan SUN, Zhenzhen CHEN, et al. Correlation analysis of basic vital signs and behavioral score of disorders of consciousness in patients with brainstem hemorrhage[J]. Journal of Third Military Medical University, 2021, 43(15): 1418-1423.
左诗怡, 孙娟, 陈珍珍, 等. 脑干出血患者基本生命体征与意识障碍行为学评分的相关性分析[J]. 第三军医大学学报, 2021,43(15):1418-1423. DOI： 10.16016/j.1000-5404.202102092.

Shiyi ZUO, Juan SUN, Zhenzhen CHEN, et al. Correlation analysis of basic vital signs and behavioral score of disorders of consciousness in patients with brainstem hemorrhage[J]. Journal of Third Military Medical University, 2021, 43(15): 1418-1423. DOI： 10.16016/j.1000-5404.202102092.

摘要

目的

研究脑干出血患者基本生命体征与意识障碍行为学评分的相关性。

方法

从陆军军医大学第二附属医院神经外科2015年1月至2020年11月收治的375例脑干出血患者中筛选出73例，依据入院后24 h内的格拉斯哥昏迷量表(Glasgow Coma Scale

GCS)评分将其分为无意识障碍组(

=38)和重度意识障碍组(

=35)，比较入院后24 h内、出院前24 h内两个时期的GCS评分及GCS中应答能力、行为认知能力、肢体对疼痛刺激反应、自行睁眼反应等行为学表现，以及腋测体温、脉搏频率和呼吸频率变化情况。根据是否有前述的行为学表现，又将重度意识障碍组患者分为有行为表现组(

=21)与无行为表现组(

=14)，比较二者的腋测体温、脉搏频率和呼吸频率变化。将无意识障碍组、重度意识障碍组入院后24 h内、出院前24 h内的GCS评分与同时期的腋测体温、脉搏频率和呼吸频率进行相关性和差异性分析。

结果

在入院后24 h内、出院前24 h内两个时期，与无意识障碍组相比，重度意识障碍组患者的GCS评分更低，腋测体温和脉搏频率频率均显著升高(

0.05)；但入院后24 h内的呼吸频率两组间差异无统计学意义，而出院前24 h内呼吸频率则在重度意识障碍组患者显著升高(

0.05)。另外，无意识障碍组、重度意识障碍组两个时期的GCS评分与同时期的腋测体温、脉搏频率和呼吸频率差异均无统计学意义。重度意识障碍患者有行为表现组与无行为表现组在两个时期的腋测体温、呼吸频率、入院后24 h内脉搏频率差异均无统计学意义，但无行为表现组出院前24 h内的脉搏频率较有行为表现组明显升高(

0.05)。

结论

脑干出血患者基本生命体征与意识障碍行为学评分紧密相关，其中入院后24 h内和出院前24 h内的腋测体温、脉搏频率的升高与意识障碍患者GCS评分降低呈显著正相关。

Abstract

Objective

To study the correlation of basic vital signs with behavioral score of disorders of consciousness (DOC) in patients with brainstem hemorrhage.

Methods

A total of 73 patients with brain stem hemorrhage were screened out from 375 patients admitted to the Department of Neurosurgery of the Second Affiliated Hospital of Army Medical University from January 2015 to November 2020. According

to the Glasgow Coma Scale (GCS) score within 24 h after admission

they were divided into normal consciousness group (

=38) and severe DOC group (

=35). Their GCS score

GCS response ability

behavioral cognitive ability

limb response to pain stimulation and eye-opening response

as well as axillary temperature

pulse rate and respiratory rate were compared between the 2 groups at the 2 time points

that is

24 h after admission and 24 h before discharge. According to the behavioral responses mentioned above

the patients out of severe DOC group were further assigned into the subgroup having behavioral responses (behavioral subgroup

=21) and the subgroup without (non-behavioral subgroup

=14)

and the changes of axillary temperature

pulse rate and respiratory rate were compared with between them. The correlations and differences among the GCS scores and axillary body temperature

pulse rate and respiratory rate were analyzed between the normal consciousness group and the severe DOC group during the 24 h after admission and 24 h before discharge.

Results

In 24 h after admission and 24 h before discharge

the patients in the severe DOC group had significantly lower GCS scores and higher mean temperature and pulse rate than the normal consciousness group (

0.05). However

there was no statistical difference in the mean respiratory rate within 24 h after admission between the 2 groups (

0.05)

and the rate within 24 h before discharge was obviously higher in the severe DOC group than another group (

0.05). In addition

no statistical correlations were observed among GCS scores and axillary temperature

pulse rate and respiratory rate in the 2 groups at the 2 time points (

0.05). There were no significant differences in the mean value of axillary temperature

pulse rate and respiratory rate within 24 h after admission between the

behavioral and non-behavioral subgroups (

0.05)

but the mean pulse rate within 24 h before discharge in the latter subgroup was significantly higher than that in the behavioral subgroups (

0.05).

Conclusion

The basic vital signs of patients with brainstem hemorrhage are closely correlated with the behavioral GCS scores of DOC

and among these signs

increased axillary temperature and pulse rate within 24 h after admission and 24 h before discharge are positively correlated with decreased GCS scores of patients with severe DOC.

关键词

Keywords

references

NASSAR H G E, GHALI A A, BAHNASY W S, et al . Vasospasm following aneurysmal subarachnoid hemorrhage: prediction, detection, and intervention[J ] . Egypt J Neurol Psychiatr Neurosurg, 2019, 55(1): 3. DOI:10.1186/s41983-018-0050-y.

夏俊, 党圆圆, 王俊, 等. 听觉失匹配负波对慢性意识障碍患者脑功能的评估作用分析[J]. 中华神经医学杂志, 2019(07): 715-719. DOT: 10.3760/cma. j. issn. 1671-8925.2019.07.012.

XIA J, DANG Y Y, WANG J, et al . Evaluation of brain function in patients with chronic disorder of consciousness by auditory mismatch negativity[J ] . Chin J Neuromed, 2019, 55(1): 3. DOI:10.1186/s41983-018-0050-y.

TAO C Y, LI H, WANG J J, et al . Predictors of surgical results in patients with primary pontine hemorrhage[J ] . Turk Neurosurg, 2016, 26(1): 77-83. DOI:10.5137/1019-5149.JTN.12634-14.1.

GIACINO J T, KATZ D I, SCHIFF N D, et al . Comprehensive systematic review update summary: disorders of consciousness: report of the guideline development, dissemination, and implementation subcommittee of the American academy of neurology; the American congress of rehabilitation medicine; and the national institute on disability, independent living, and rehabilitation research[J ] . Neurology, 2018, 91(10): 461-470. DOI:10.1212/WNL.0000000000005928.

ROHAUT B, DOYLE K W, REYNOLDS A S, et al . Deep structural brain lesions associated with consciousness impairment early after hemorrhagic stroke[J ] . Sci Rep, 2019, 9(1): 4174. DOI:10.1038/s41598-019-41042-2.

TEASDALE G, JENNETT B. Assessment of Coma and impaired consciousness. A practical scale[J]. Lancet, 1974, 2(7872): 81-84. DOI:10.1016/s0140-6736(74)91639-0.

BODART O, GOSSERIES O, WANNEZ S, et al . Measures of metabolism and complexity in the brain of patients with disorders of consciousness[J ] . Neuroimage Clin, 2017, 14: 354-362. DOI:10.1016/j.nicl.2017.02.002.

曹勇, 张谦, 于洮, 等. 中国脑血管病临床管理指南(节选版): 脑出血临床管理[J]. 中国卒中杂志, 2019, 14(8): 809-813.

CAO Y, ZHANG Q, YU T, et al . Chinese stroke association guidelines for clinical management of cerebrovascular disorders (excerpts)—clinical management of intracerebral hemorrhage[J ] . Chin J Stroke, 2019, 14(8): 809-813.

沈抒. 修订版昏迷恢复量表简介及临床研究进展[J]. 中华物理医学与康复杂志, 2015, 37(8): 628-630. DOI:10.3760/cma.j.issn.0254-1424.2015.08.022.

SHEN S. Introduction and clinical research progress of the revised coma recovery scale[J]. Chin J Physical Med Rehabil, 2015, 37(8): 628-630. DOI:10.3760/cma.j.issn.0254-1424.2015.08.022.

葛红飞, 张超, 尹怡, 等. 原发性脑干出血患者死亡的独立危险因素分析[J]. 中华神经外科杂志, 2019(06): 588-591. DOI:10.3760/cma.j.issn.1001-2346.2019.06.010.

GE H F, ZHANG C, YIN Y, et al . Analysis of independent risk factors in deaths of patients with primary brainstem hemorrhage[J ] . Chin J Neurosurg, 2019(06): 588-591. DOI:10.3760/cma.j.issn.1001-2346.2019.06.010.

龚金兵, 张占伟, 张蕾, 等. 微创软通道穿刺引流术治疗高血压性重症脑干出血的疗效观察[J]. 中国微侵袭神经外科杂志, 2020, 25(3): 124-125. DOI:10.11850/j.issn.1009-122x.2020.03.109.

GONG J B, ZHANG Z W, ZHANG L, et al . Observation on the curative effect of minimally invasive soft channel puncture and drainage in the treatment of severe hypertensive brain stem hemorrhage[J ] . Chin J Minim Invas Neurosurg, 2020, 25(3): 124-125. DOI:10.11850/j.issn.1009-122x.2020.03.109.

THIBAUT A, BODIEN YG, LAUREYS S, GIACINO J T. Minimally conscious state "plus": diagnostic criteria and relation to functional recovery[J]. J Neurol, 2020, 267(5): 1245-1254. DOI: 10.1007/s00415- 019-09628-y.

SCHNAKERS C, VANHAUDENHUYSE A, GIACINO J, et al . Diagnostic accuracy of th e vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment[J ] . BMC Neurol, 2009, 9: 35. DOI:10.1186/1471-2377-9-35.

何江弘, 谢秋幼, 徐如祥. 《欧洲昏迷和意识障碍诊断指南》(2020版)解读[J]. 中华神经创伤外科电子杂志, 2020, 6(3): 135-140. DOI:10.3877/cm.cma.j.issn.2095-9141.2020.03.002.

HE J H, XIE Q Y, XU R X. Interpretation of European Academy of Neurology guideline on the diagnosis of Coma and other disorders of consciousness (Version 2020)[J]. Chin J Neurotraum Surg Electron Ed, 2020, 6(3): 135-140. DOI:10.3877/cm.cma.j.issn.2095-9141.2020.03.002.

高武云, 马万明, 张亚军, 等. 老年原发性脑干出血后死亡的危险因素分析[J]. 中国实用医刊, 2020(02): 61-62. DOI:10.3760/cma.j.issn.1674-4756.2020.02.018.

GAO W Y, MA W M, ZHANG Y J, et al . Analysis of risk factors of death after primary brainstem hemorrhage in the elderly[J ] . Chin J Pract Med, 2020(02): 61- 62. DOI:10.3760/cma.j.issn.1674-4756.2020.02.018.

王立侠, 陈芳芳, 朱雪瑞, 等. 床旁神经电生理监测在重症监护室意识障碍患者中的应用分析[J]. 中国实用神经疾病杂志, 2019, 22(24): 2706-2712.

WANG L X, CHEN F F, ZHU X R, et al . Analysis of bedside neuroelectrophysiological monitoring in patients with severe disturbance of consciousness[J ] . Chin J Pract Nerv Dis, 2019, 22(24): 2706-2712.

WANG J, HU X, HU Z, et al . The misdiagnosis of prolonged disorders of consciousness by a clinical consensus compared with repeated Coma-recovery scale-revised assessment[J ] . BMC Neurol, 2020, 20(1): 343. DOI:10.1186/s12883-020-01924-9.

董月青. 《意识障碍临床实践指南更新摘要》解读与中国的现状[J]. 武警医学, 2020, 31(5): 369-372, 385. DOI:10.14010/j.cnki.wjyx.2020.05.002.

DONG Y Q. Interpretation of the updated abstract of clinical practice guide of consciousness disorders and status quo in China[J]. Med J Chin PAPF, 2020, 31(5): 369-372, 385. DOI:10.14010/j.cnki.wjyx.2020.05.002.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

尿足细胞数量及podocalyxin蛋白与IgA肾病的相关性

低血糖意识障碍的相关危险因素分析

急性脑梗死患者外周血白细胞水平对意识障碍程度的评估价值

影响慢性意识障碍合并气管切开患者拔管因素的分析

CT征象预测原发性脑干出血患者意识障碍程度的价值