脑干反射对重型颅脑损伤长期意识障碍的清醒预测及预后评估

目的：探讨脑干发射(BSR)对重型颅脑损伤长期意识障碍患者的清醒及预后评估中的作用。方法选择2013年8月至2015年8月期间120例重型颅脑损伤患者为研究对象。统计BSR分级、GCS分级与重型颅脑损伤患者清醒率的关系及相关性、重型颅脑损伤患者BSR分级与GOS评分的关系、BSR分级与预后的关系及相关性。结果 BSR不同分级间患者清醒率差异有统计学意义(P<0.01)；GCS分级中无Ⅰ级患者，GCS不同分级间患者清醒率差异有统计学意义(P<0.01)；BSR分级与重型颅脑损伤清醒率呈明显负相关(r=-0.672，P=0.005)，GCS分级与重型颅脑损伤清醒率无明显相关性(r=-0.135，P=0.298)；BSR分级预测重型颅脑损伤清醒的敏感性和特异性分别为80.6%和87.5%，准确率达83.3%。由于GCS分级无Ⅰ级，其与重型颅脑损伤患者清醒情况无相关性，因此无法用于重型颅脑损伤患者清醒的预测；重型颅脑损伤患者BSR分级与GOS评分之间差异有统计学意义(P<0.01)；重型颅脑损伤患者BSR不同分级之间患者预后差异有统计学意义(P<0.01)；重型颅脑损伤患者BSR分级Ⅰ~Ⅱ级患者预后明显好于BSR分级Ⅲ~Ⅳ级；BSR分级与重型颅脑损伤预后呈明显负相关(r=-0.636，P=0.000)。结论 BSR分级可用于重型颅脑损伤长期意识障碍患者清醒状况和预后的预测；BSR分级与重型颅脑损伤患者清醒及预后关系密切，BSR分级越高，重型颅脑损伤患者清醒的概率越低，预后越差。

Clinical effect of brainstem reflex on prediction of outcome of awakening and assessment of prognoses in patients with long-term unconsciousness after severe traumatic brain injury

Objective To study the clinical effect of brainstem reflex (BSR) on prediction of outcome of awak-ening and assessment of prognoses in patients with long-term unconsciousness after severe traumatic brain injury (TBI). Methods During the period of August 2013 to August 2015, 120 patients with long-term unconsciousness after severe traumatic brain injury were selected as the research objects. The relationship of statistical BSR grade, Glasgow Coma Scale (GCS) grade with the awake rate of patients with severe TBI and the relationship of BSR classification in patients with severe TBI with Glasgow Outcome Scale (GOS) score and prognosis were analyzed. Results There were signifi-cant differences between various BSR grades patients in the awake rate (P<0.01); Patients with GCS grading have no BSR Ⅰ grade, and there were significantly differences between different GCS grade patients in awake rate (P<0.01). BSR grade had a negative correlation with awake rate of patients with severe TBI (r=-0.672, P=0.005), while GCS grade had no significant correlation with awake rate of patients with severe TBI (r=-0.135, P=0.298). The sensitivity and speci-ficity of BSR classification on prediction of outcome of awakening were respectively 80.6%and 87.5%, and the accura-cy rate was up to 83.3%. Because patients with GCS grading have no BSR I grade, which had no correlation with the awakening in patients with severe TBI, it cannot be used for prediction of the outcome of awakening. There was a signifi-cant difference between BSR grade and GOS score in patients with severe TBI (P<0.01). There was a significant differ-ence between BSR grades and prognosis in patients with severe TBI (P<0.01). The prognosis of BSR class Ⅰ~Ⅱpa-tients with severe TBI was better than that of BSR class Ⅲ~Ⅳ, and BSR grading had a negative correlation with the prognosis of severe TBI (r=-0.636, P=0.000). Conclusion BSR classification can be employed to the prediction of out-come of awakening and assessment of prognoses in patients with long-term unconsciousness after severe traumatic brain injury. BSR classification has a close relationship with awakening and prognoses in patients with severe TBI. The higher the BSR grade, the lower the awakening probability of severe TBI patients, and the worse the prognosis.