脑损伤后慢性意识障碍康复影响因素及治疗策略的回顾性分析

关键词：慢性意识障碍  影响因素  康复治疗  脑损伤

Keywords:prolonged disorders of consciousness  influencing factors  rehabilitation therapy  brain injury

摘要：

      摘要 目的：探讨脑损伤后慢性意识障碍（DOC）患者康复治疗过程中影响意识水平恢复的潜在因素，以及脑损伤后治疗策略对意识水平恢复的影响。 方法：回顾分析2017—2022年期间在我院康复医学科收治的72例脑损伤后DOC患者的临床资料、意识水平评分、临床用药情况、康复治疗方案等进行回顾性分析。 结果：气管切开拔管困难、脑积水、肌张力异常升高、感染控制不佳、非感染性并发症控制不佳等因素对意识水平改善有显著影响；药物方面，注射肉毒毒素控制肌张力、使用金刚烷胺对意识水平改善有显著影响；使用选择性5-羟色胺再摄取抑制剂（SSRIs）对意识水平可能有改善的趋势，但尚无显著性差异。 结论：在脑损伤后DOC患者康复治疗过程中，应去除影响意识水平的因素，包括控制感染、控制并发症、如有条件尽早拔除气管切开套管、积极处理脑积水、局部注射肉毒毒素控制异常升高的肌张力，并应用可能改善意识水平的药物，如金刚烷胺、SSRIs等。

Abstract:

      Abstract Objective：To investigate the potential factors influencing the recovery of consciousness levels during the rehabilitation process of patients with prolonged disorders of consciousness （DOC） following brain injury， and to assess the impact of different treatment strategies on consciousness level recovery. Method：A retrospective analysis was conducted on clinical data， consciousness level scores， clinical medication usage， and rehabilitation treatment plans of 72 patients with DOC who were admitted to our rehabilitation medicine department from 2017 to 2022. Result：Factors such as difficulty in tracheostomy tube removal， hydrocephalus， elevated muscular tension abnormalities， poor infection control， and inadequate control of non-infectious complications significantly affected the improvement of consciousness levels. Regarding medications， the injection of botulinum toxin for muscular tension control and the use of amantadine had a significant impact on improving consciousness levels. The use of selective serotonin reuptake inhibitors （SSRIs） showed a trend towards improving consciousness levels， but the differences were not statistically significant. Conclusion：During the rehabilitation process of patients with DOC following brain injury， addressing factors that influence consciousness levels is crucial. These factors include effective infection control， management of complications， early removal of tracheostomy tubes when feasible， active management of hydrocephalus， local injection of botulinum toxin to control elevated muscular tension， and the use of medications that may improve consciousness levels， such as amantadine and SSRIs.