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Objective: To evaluate the effects of an increase in the intensity of rehabilitation on the functional outcome of patients with traumatic brain injury (TBI).
Design and methods: Sixty-eight patients (age 12-65 years) with moderate-to-severe TBI were included. They were randomized into high (4-hour/day) or control (2-hour/day) intensity rehabilitation programmes at an average of 20 days after the injury. The programmes ended when the patients achieved independence in daily activities or when 6 months had passed.
Outcome and results: No significant differences were found in the Functional Independence Measure (FIM) (primary outcome) and Neurobehavioural Cognitive Status Examination (NCSE) total scores between the two groups. There were significantly more patients in the high intensity group than in the control group who achieved a maximum FIM total score at the third month (47% vs. 19%, p = 0.015) and a maximum Glasgow Outcome Scale (GOS) score at the second (28% vs. 8%, p = 0.034) and third months (34% vs. 14%, p = 0.044).
Conclusions: Early intensive rehabilitation may improve the functional outcome of patients with TBI in the early months post-injury and hence increase the chance of their returning to work early. Intensive rehabilitation in this study speeded up recovery rather than changed the final outcome. 相似文献
Design and methods: Sixty-eight patients (age 12-65 years) with moderate-to-severe TBI were included. They were randomized into high (4-hour/day) or control (2-hour/day) intensity rehabilitation programmes at an average of 20 days after the injury. The programmes ended when the patients achieved independence in daily activities or when 6 months had passed.
Outcome and results: No significant differences were found in the Functional Independence Measure (FIM) (primary outcome) and Neurobehavioural Cognitive Status Examination (NCSE) total scores between the two groups. There were significantly more patients in the high intensity group than in the control group who achieved a maximum FIM total score at the third month (47% vs. 19%, p = 0.015) and a maximum Glasgow Outcome Scale (GOS) score at the second (28% vs. 8%, p = 0.034) and third months (34% vs. 14%, p = 0.044).
Conclusions: Early intensive rehabilitation may improve the functional outcome of patients with TBI in the early months post-injury and hence increase the chance of their returning to work early. Intensive rehabilitation in this study speeded up recovery rather than changed the final outcome. 相似文献
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贾起华 《中国实用神经疾病杂志》2017,20(15)
目的研究高压氧治疗颅脑损伤患者在不同时间的临床治疗效果。方法选取2013-01—2016-01我院确诊为颅脑损伤的患者300例,随机分为3组进行研究,Ⅰ组83例为1周内行高压氧治疗的患者;Ⅱ组95例为入院1~4周行高压氧治疗的患者;Ⅲ组122例为4周以上行高压氧治疗的患者。记录3组治疗前与治疗后NCSE评分,采用FIM对3组患者行独立功能评价,比较治疗前后的总有效率。结果经我院高压氧治疗后3组患者认知功能及独立功能均明显有效于治疗前(P0.05),Ⅰ组的认知功能优于Ⅱ组和Ⅲ组(P0.05),但Ⅱ组和Ⅲ组无差异性(P0.05);FIM评价治疗后3组患者恢复效果明显高于治疗前(P0.05);Ⅱ组、Ⅲ组患者FIM数据明显低于Ⅰ组,差异具有统计学意义(P0.05),Ⅱ组、Ⅲ组间无显著差异(P0.05),Ⅰ组治疗总有效率显示高于其他2组,差异具有统计学意义(P0.05)。结论早期接受高压氧治疗可明显缓解或治愈颅脑损伤,最大程度提升认知功能,促使患者早日恢复自主生活能力,值得推广应用。 相似文献
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Purpose
Changes in electroencephalography (EEG) patterns may offer a clue to the cause of altered mental status and suggest the prognoses of patients with such mental status. We aimed to identify the EEG patterns in patients with altered mental status and to correlate EEG findings with clinical prognoses.Materials and Methods
We included 105 patients with altered mental status who underwent EEG. EEG and clinical chart reviews with ongoing patient follow-ups were performed to determine the clinical prognosis of the patients. Clinical data were sorted using the Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS). EEG findings were classified according to a method suggested by Scollo-Lavizzari. The EEGs were analyzed to find out whether any correlation existed with the prognoses of patients.Results
Nonconvulsive status epilepticus (NCSE) was detected in only three patients (2.9%). Specific EEG patterns were observed in 28 patients. Twenty-nine (27.6%) patients expired, and 45 (42.9%) patients were in a vegetative state. EEG grade and GCS significantly correlated with GOS. EEG grade alone had a correlation with GCS. Patients with a severe EEG finding had a poor prognosis.Conclusion
EEG findings reflect the mental status of patients, and EEG grades are correlated with the clinical prognosis of patients. Although EEG is not frequently performed on patients with altered mental state, it can play a supplemental role in establishing a prognosis. Thus, the use of EEG should be emphasized in clinical setting. 相似文献5.
Tetsuhiro Fukuyama Shouko Yamauchi Shunsuke Amagasa Yuka Hattori Taku Sasaki Hideko Nakajima Yuko Takei Jiu Okuno Yuka Misawa Noboru Fueki Masatomo Kitamura Hikoro Matsui Yuji Inaba Shinichi Hirabayashi 《Brain & development》2018,40(8):707-713
Objective
The aim of this study was to determine the prognostic factors for acute encephalopathy with reduced diffusion (AED) during the acute phase through retrospective case evaluation.Methods
The participants included 23 patients with AED. The diagnosis of AED was based on their clinical course and radiological findings. We divided the patients into severe and non-severe groups based on the neurodevelopmental outcome. The severe group included seven patients (median age, 21?months; range, 6–87?months) and the non-severe group included 16 patients (19?months, 9–58?months). Clinical symptoms, laboratory data and electroencephalogram (EEG) findings within 48?h from the initial seizure onset were compared between the two groups to identify neurological outcome predictors.Results
The incidence of coma 12–24?h after onset, serum creatinine (Cr) levels within 2?h after onset, maximum aspartate aminotransferase (AST) levels within 24?h after onset, and the rate of electrographic seizures in EEG were significantly higher in the severe group (Coma, 80%; Cr, 0.40?mg/dl, 0.37–0.73; AST, 363 IU/L, 104–662; electrographic seizures, 80%) than the non-severe group (Coma, 0%; Cr, 0.29?mg/dL, 0.19–0.45; AST, 58.5 IU/L, 30–386; electrographic seizures, 0%).Conclusions
Coma 12–24?h after onset, elevation of Cr levels within 2?h after onset, elevation of AST levels within 24?h after onset, and non-convulsive status epileptics (NCSE) in comatose patients were early predictors of severe AED. Patients in a coma after a febrile seizure should be checked for NCSE signs in EEG to terminate NCSE without delay. 相似文献6.
Amy Z. Crepeau Jennifer E. Fugate Jay Mandrekar Roger D. White Eelco F. Wijdicks Alejandro A. Rabinstein Jeffrey W. Britton 《Resuscitation》2014
Introduction
Therapeutic hypothermia (TH) is standard of care after ventricular fibrillation cardiac arrest (CA). Continuous EEG monitoring (cEEG) is increasingly used during TH. Analysis regarding value of cEEG utilization in this population in the context of cost and outcome has not been performed. We compared outcome and EEG charges in CA patients with selective versus routine cEEG.Methods
A protocol for TH after CA without routine cEEG was implemented in December 2005, comprising our TH-pre-cEEG cohort. In November 2009, this protocol was changed to include cEEG in all CA–TH patients, comprising our TH-cEEG cohort. Clinical outcome using the Cerebral Performance Category (CPC) at discharge and estimated EEG charges were calculated retrospectively for both cohorts, based on National Charge Data 50th percentile charges expressed in USD per the CMS 2010 Standard Analytical File as reported in Code Correct by MedAssets, Inc.Results
Our TH-pre-cEEG cohort comprised 91 patients, our TH-cEEG cohort 62. In the TH-pre-cEEG cohort, 19 patients (21%) had rEEGs, 4 (4%) underwent cEEG. The mean estimated EEG charges for the TH-pre-cEEG cohort was $1571.59/patient, and TH-cEEG cohort was $4214.93/patient (p < 0.0001). Two patients (2.1%) in the TH-pre-cEEG cohort had seizures, compared to five (8.1%) in the TH-cEEG cohort (p = 0.088). There was no difference in mortality or clinical outcome in these cohorts.Conclusions
Routine use of cEEG during TH after CA improved seizure detection, but not outcomes. There was a three-fold increase in EEG estimated charges with routine use of cEEG. 相似文献7.
目的：探讨非惊厥性癫癎持续状态（NCSE）发作期的药物治疗。方法：对本院确诊的2例NCSE患者的临床症状,视频脑电图及药物治疗效果进行分析。结果：2例 NCSE患者发作类型相同,发作期的异常放电不同,临床症状和异常脑电对药物反应不同。结论：发作形式为复杂部分性发作（CPS）的NCSE患者,是否需要给予地西泮静推,如果需要,如何把握药物剂量,还需进一步大样本的临床观察。 相似文献
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目的 探讨丹膝颗粒联合曲克芦丁治疗急性脑梗死恢复期的临床疗效。方法 选取2018年6月—2023年6月国家电网公司北京电力医院脑神经内科收治的120例急性脑梗死恢复期患者,按照随机数字表法将所有患者分为对照组和治疗组,每组各60例。对照组患者静脉滴注曲克芦丁氯化钠注射液,0.48 g/次,1次/d。治疗组在对照组的治疗基础上口服丹膝颗粒,1袋/次,3次/d。两组用药20 d观察治疗情况。观察两组临床疗效,比较两组症状好转时间、神经行为认知状态检查表（NCSE）评分、日常生活活动能力量表（ADL）评分、脂蛋白相关磷脂酶A2（Lp-PLA2）、神经元特异性烯醇化酶（NSE）、脑源性神经营养因子（BDNF）、同型半胱氨酸（Hcy）水平及不良反应情况。结果 治疗后,治疗组总有效率是96.67%,显著高于对照组的83.33%（P＜0.05）。治疗后,治疗组头晕、眩晕、肢体麻木、中枢性面瘫好转时间均显著短于对照组（P＜0.05）。治疗后,两组NCSE评分、ADL评分均显著高于同组治疗前（P＜0.05）;且治疗后,治疗组NCSE评分、ADL评分高于对照组（P＜0.05）。治疗后,两组Lp-PLA2、NSE、Hcy水平均显著降低,而BDNF水平显著升高（P＜0.05）;治疗后治疗组Lp-PLA2、NSE、Hcy水平低于对照组,而BDNF水平高于对照组（P＜0.05）。治疗后,治疗组不良反应发生率是5.01%,显著低于对照组的13.33%（P＜0.05）。结论 丹膝颗粒联合曲克芦丁治疗脑梗死恢复期具有较好的临床疗效,显著提高患者神经行为认知能力和日常活动能力,降低机体炎症反应,值得临床借鉴应用。 相似文献
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神经行为认知状态检查表信度与效度的初步测定 总被引：5，自引：3，他引：5
目的 引进神经行为认知状态检查表 (NCSE)并测定中文NCSE的信度和效度。方法 以康复科住院病人 2 5例为样本 ,间隔 1周评定重测信度。以康复科因脑损伤而住院的患者 5 5例为样本 ,评定效度。结果 绝大部分项目重测信度好 (r >0 .7,P <0 .0 1) ;5 5例脑损伤患者 ,被神经康复专家临床评定分为两组 (正常组和认知功能障碍组 ) ,认知功能障碍组在中文NCSE中的得分低于正常组 (P <0 .0 1) ;中文NCSE的语言项目与CRRCAE 中国康复研究中心失语症检测结果相关性强 ((r =0 .72 -0 .78,P <0 .0 1) ,记忆项目与Rivermead行为记忆能力评定结果的相关性强 (r =0 .72 ,P <0 .0 1) ;以量表给定的临界值为标准 ,中文NCSE对器质性脑损伤患者认知功能障碍的临床诊断灵敏度为 93 .5 % ,特异度为 65 %。结论 中文NCSE经初步测试 ,信度和效度基本满意 ,尤其适用于器质性脑损伤患者的筛选 ,建议扩大样本临床试用。 相似文献