Dysautonomia after traumatic brain injury: a forgotten syndrome?
Dysautonomia after traumatic brain injury: a forgotten syndrome?
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DOI：
10.1136/jnnp.67.1.39
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发表时间：
1999-07-01
影响因子：
11
通讯作者：
Wade, LD
中科院分区：
文献类型：
--
作者：
Baguley, IJ;Nicholls, JL;Wade, LD
目的更好地了解外伤性脑损伤后自主神经异常的临床特点、自然病史、临床处理及康复意义，并指出以往命名的难点。方法：回顾性分析35例自主神经异常患者和35例性别和格拉斯哥昏迷评分相匹配的对照。比较各组的损伤细节、CT表现、生理指标、损伤后前28天的感染证据、临床进展和康复结果。结果：自主神经异常组在除重症监护时间、临床显著感染发生率和功能独立性测量（FIM）评分变化外的所有变量上均明显差于对照组。结论：自主神经异常是一种独特的临床综合征，与严重弥漫性轴索损伤和入院前缺氧有关。它与较差的功能预后有关；然而，通过FIM评分的变化，对照组和自主神经异常患者都显示出相似程度的改善。有人认为，延迟识别和治疗自主神经异常导致可预防的发病率增加。
Objectives-To better establish the clinical features, natural history, clinical management, and rehabilitation implications of dysautonomia after traumatic brain injury, and to highlight difficulties with previous nomenclature.Methods-Retrospective file review on 35 patients with dysautonomia and 35 sex and Glasgow coma scale score matched controls. Groups were compared on injury details, CT findings, physiological indices, and evidence of infections over the first 28 days after injury, clinical progress, and rehabilitation outcome.Results-the dysautonomia group were significantly worse than the control group on all variables studied except duration of stay in intensive care, the rate of clinically significant infections found, and changes in functional independence measure (FIM) scores.Conclusions-Dysautonomia is a distinct clinical syndrome, associated with severe diffuse axonal injury and preadmission hypoxia. It is associated with a poorer functional outcome; however, both the controls and patients with dysautonomia show a similar magnitude of improvement as measured by changes in FIM scores. It is argued that delayed recognition and treatment of dysautonomia results in a preventable increase in morbidity.