意识障碍患者的临床并发症分析

目的研究意识障碍(disturbance of consciousness,DOC)患者康复治疗期间并发症的种类及发病率。方法统计分析中国人民解放军南部战区总医院2016年6月—2018年6月收治的186例慢性DOC患者住院期间发生的所有并发症。按照致病因素,将患者分为创伤性颅脑损伤组(107例)和非创伤性颅脑损伤组(79例);按并发症类型分为颅脑相关性(105例次)和非颅脑相关性(280例次),非颅脑相关性并发症分为感染性(154例次)和非感染性(126例次)。计算各类并发症的发病率;对肺部感染及泌尿系感染进行致病菌型分析;比较创伤性颅脑损伤组与非创伤性颅脑损伤组患者各类并发症的发病率。并分析主要并发症与患者年龄、性别、昏迷时间、昏迷程度、有无气管切开、有无尿管、是否吸烟、是否给予早期康复治疗等因素的相关性。结果所有并发症中,感染性并发症所占比例最高,其中肺部感染最多;其主要致病菌是铜绿假单胞菌和鲍曼不动杆菌。颅脑相关性并发症中,以脑积水最多;非感染性并发症中,以阵发性交感神经兴奋性增高(paroxysmal sympathetic hyperactivity,PSH)最多。创伤性颅脑损伤组的脑积水发病率明显高于非创伤性颅脑损伤组,差异有统计学意义(P=0.002);非创伤性颅脑损伤组的PSH发病率明显高于创伤性颅脑损伤组,差异有统计学意义(P=0.015)。DOC程度是DOC患者发生肺部感染、尿路感染、脑积水、PSH的危险因素;年龄≥50岁是肺部感染、尿路感染、PSH的危险因素。此外,气管切开、吸烟、性别均是DOC患者发生肺部感染的危险因素;留置尿管是DOC患者发生尿路感染的危险因素;DOC时间是DOC患者发生PSH的危险因素。结论肺部感染、脑积水、PSH是慢性DOC患者治疗康复过程中最常见的并发症,创伤性颅脑损伤患者与非创伤性颅脑损伤患者的并发症分型和发病率均有明显差异。为节约医疗成本、改善患者预后,在康复治疗期间应对以上几种并发症进行重点防治。

Analysis and study of clinical complications in patients with disturbance of consciousness

Objective To analyze the types and incidence of complications during rehabilitation treatment in patients with disturbance of consciousness(DOC).Methods All complications of 186 patients with DOC admitted to General Hospital of Southern Theater Command,PLA from Jun 2014 to Jun 2016 were analyzed.All patients were devided into traumatic brain injury(TBI)group(n=107)and non-traumatic brain injury(nTBI)group(n=79).All complications were classified into the brain-related(n=105)and non-brain-related(n=280)diseases according to the type.The non-brain-related complications were classified as infective(n=154)and non-infective(n=126)complications.The incidence of various complications,the pathogenic bacteria of lung infections and urinary tract infections were analyzed.The incidence of complications in patients with TBI and nTBI was compared.And the correlations of the main complications with age,gender,DOC time,DOC degree,tracheotomy,urethral catheter,smoking,and early rehabilitation were analyzed.Results Infectious complications was the most common complication and pneumonia accounted for the highest proportion infectious complications.Hydrocephalus was most complication in brain-related complications,as paroxysmal sympathetic hyperactivity(PSH)was most common in non-brain-related complications.The incidence of hydrocephalus increased significantly in the TBI group compared with nTBI group and the incidence of PSH increased significantly in the nTBI group compared with TBI group.DOC degreewas a risk factor for pulmonary infection,urinary tract infection,hydrocephalus,and PSH in DOC patients,age over 50 years was a risk factor for lung infection,urinary tract infection and PSH.In addition,tracheotomy,smoking,and gender are risk factors for lung infection in DOC patients,indwelling catheter was a risk factor for urinary tract infection in DOC patients,and DOC time was a risk factor for PSH in DOC patients.Conclusions Infectious complications,hydrocephalus,and PSH are the most common complications in patients with chronic DOC,we should focus on prevention and treatment of the above complications during daily rehabilitation for saving medical costs and improving patient prognosis.