Predictors of recovery of responsiveness in prolonged anoxic vegetative state
Predictors of recovery of responsiveness in prolonged anoxic vegetative state
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DOI：
10.1212/wnl.0b013e31827f0f31
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发表时间：
2013-01-01
期刊：
影响因子：
9.9
通讯作者：
Trojano, Luigi
中科院分区：
文献类型：
--
作者：
Estraneo, Anna;Moretta, Pasquale;Trojano, Luigi
目的：缺氧后植物状态（VS）持续时间延长的患者日益增多。然而，很少有资料可用于长期预后指标的患者谁留在VS超过1个月后发病。本2年的前瞻性临床研究的目的是确定预后标志物，记录在慢性期，这可能是有用的预测恢复的反应后缺氧VS patients.Methods的队列：我们招募了43例住院患者长期缺氧VS（23名女性，年龄范围12 - 83岁）。我们收集了研究开始时的病史、临床表现和神经生理学评估的数据（发病后1 - 6个月），并在发病后24个月评估其与结果的关系;为了定义结果，根据临床标准和昏迷恢复量表修订版（CRS-R）将患者分类为有反应或无反应。9例患者已恢复反应（但其中2人死亡后觉醒），而12例患者仍在VS和22人死于VS。功能能力受到严重影响，在所有响应的幸存者。与未恢复的患者相比，有反应的患者明显更年轻，在进入研究时显示出更高的CRS-R总分和更低的残疾评定量表评分。所有有反应的幸存者都没有瞳孔对光反射和伤害性反应，以及阵发性交感神经亢进。Logistic回归分析显示，正中神经体感诱发电位的存在和CRS-R总分>= 6是反应性恢复的重要预测因素。结论：临床特征和诱发电位是长期缺氧后VS患者反应性长期恢复的有用预测因素。Neurology（R）2013; 80：464 - 470
Objective: The number of patients in prolonged postanoxic vegetative state (VS) is increasing. However, little information is available about prognostic markers of long-term outcome in patients who remain in VS more than 1 month postonset. The present 2-year prospective clinical study aimed to identify prognostic markers, recorded in the chronic phase, that might be useful for predicting recovery of responsiveness in a cohort of postanoxic VS patients.Methods: We enrolled 43 inpatients with prolonged anoxic VS (23 female; age range 12-83 years). We collected data about medical history, clinical findings, and neurophysiological assessments at study entry (1-6 months postonset), and assessed their relationships with outcome at 24 months postonset; for defining outcome, patients were classified as responsive or unresponsive on the basis of clinical criteria and on Coma Recovery Scale-Revised (CRS-R).Results: Nine patients had recovered responsiveness (but 2 of them died after awakening), whereas 12 patients remained in VS and 22 had died in VS. Functional abilities were severely affected in all responsive survivors. Responsive patients were significantly younger and showed higher CRS-R total score and lower Disability Rating Scale score at study entry than patients who did not recover. All responsive survivors had spared pupillary light reflex and nociceptive response, and paroxysmal sympathetic hyperactivity. Logistic regression analysis showed that the presence of median nerve somatosensory evoked potentials and CRS-R total score >= 6 were significant predictors of recovery of responsiveness.Conclusions: Clinical features and evoked potentials are useful predictors of long-term recovery of responsiveness in patients with prolonged postanoxic VS. Neurology (R) 2013;80:464-470