Hepatic Encephalopathy and Fitness to Drive
Hepatic Encephalopathy and Fitness to Drive
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DOI：
10.1053/j.gastro.2009.08.003
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发表时间：
2009-11-01
期刊：
影响因子：
29.4
通讯作者：
Haeussinger, Dieter
中科院分区：
文献类型：
--
作者：
Kircheis, Gerald;Knoche, Anja;Haeussinger, Dieter
背景与目的：轻度肝性脑病（HE）可能损害驾驶能力。驾驶缺陷尚未被描述，其与心理测试结果的关系尚不清楚。方法：51名癫痫患者和48名年龄匹配的对照者在装有多传感器和摄像头的汽车中进行了真实的驾驶，实验室和“车内”计算机心理测量，以及驾驶教练的评估。研究结果：肝硬化患者无肝性脑病（HE 0）; 27例和14例患者分别患有轻微HE（mHE）和明显HE I级（oHE）。在真实的驾驶过程中，mHE和oHE患者与对照组或慢性HE 0患者相比，表现出明显更多的车道保持违规行为，减少了休息时间，延长了反应时间，降低了应激耐受性。在自我评估问卷、mHE和oHE（但不是HEO）中，患者严重高估了自己的驾驶能力。根据驾驶教练的评估，分别有75%、48%和39%的HE 0、mHE和oHE患者适合驾驶，而对照组为87%。oHE患者的驾驶缺陷主要是由于认知缺陷和反应时间延长，而在mHE患者中，错误和注意力缺陷占主导地位。计算机心理测试结果恶化与HE严重程度和年龄，而真实的驾驶是年龄无关的。在94名患者中，有25名获得了驾驶健身的不一致结果（驾驶教练的评估与计算机心理测量）;在mHE和oHE患者中，一致率分别仅为62%和64%。结论：尽管有明显的驾驶缺陷，但HE患者高估了自己的驾驶能力。mHE的存在并不一定能预测驾驶不健康，基于计算机的测试也不能可靠地预测驾驶健康。
BACKGROUND & AIMS: Low-grade hepatic encephalopathy (HE) may impair fitness to drive. Driving deficits have not yet been characterized, and their relation to psychometric test results is unclear. METHODS: Fifty-one cirrhotic patients and 48 age-matched controls underwent real driving in a multiple sensor and camera-equipped car, laboratory and "in-car" computer psychometry, and driving instructor's assessment. RESULTS: en cirrhotic patients had no hepatic encephalopathy (HE0); 27 and 14 patients suffered from minimal HE (mHE) and overt HE grade I (oHE), respectively. During real driving, mHE and oHE patients showed significantly more violations of in-lane keeping, reduced break use, prolonged reaction times, and diminished stress tolerance compared with control or cirrhotic HE0 patients. In a self- evaluation questionnaire, mHE and oHE, but not the HEO, patients strongly overestimated their driving abilities. According to the driving instructor's assessment, 75%, 48%, and 39% of the patients with HE0, mHE, and oHE, respectively, were fit to drive, compared with 87% in the control group. Driving deficits in oHE patients were largely due to cognitive defects and prolonged reaction times, whereas, in mHE patients, mistakes and attention deficits predominated. Computer psychometric test results worsened with HE severity and age, whereas real driving was age independent. In 25 out of 94 patients, discordant results for driving fitness were obtained (driving instructor's assessment vs computer psychometry); in mHE and oHE patients, the concordance rates were only 62% and 64%, respectively. CONCLUSIONS: Despite significant driving deficits, HE patients overestimate their driving abilities. The presence of mHE does not necessarily predict driving unfitness, and computer-based testings cannot reliably predict driving fitness.