赵伟丽　何玲君　崔可

[摘要] 目的 探討行为量表与ICU病房意识障碍（Disorders of consiousness，DOC）患者预后的关系。 方法 选择2018年1～12月在我院ICU治疗的意识障碍患者为研究对象，根据随访GOS评分分为预后良好组39例与预后不良组29例。比较两组一般资料及临床资料、CRS-R评分以及EEG结果。多因素分析影响患者预后的相关因素。分析GRS-R评分与GOS评分的相关性。 结果 （1）随访3个月，其中39例恢复良好，占57.35%，29例恢复不良，占42.65%。（2）预后良好组患者CRS-R评分显著高于预后不良组的患者，EEGⅠ～Ⅱ的比例显著高于预后不良组的患者，差异有统计学意义（P<0.05）。（3）多因素分析结果显示，CRS-R评分、EEG是ICU病房DOC患者预后的相关影响因素（OR=8.712、5.709，P<0.05）。（4）CRS-R评分与GOS评分呈显著正相关关系（r=0.903）。 结论 ICU病房DOC患者的预后与入院时CRS-R评分以及EEG检查结果有密切的关系，临床上患者入院时通过CRS-R评分以及EEG检查可对患者病情以及预后进行初步判断。

[关键词] 昏迷恢复量表;ICU;意识障碍;预后

[中图分类号] R749          [文献标识码] A          [文章编号] 1673-9701（2020）11-0018-04

Relationship between coma recovery scale and the prognosis of DOC patients in ICU ward

ZHAO Weili1   HE Lingjun2   CUI Ke1

1.Department of Critical Care Medicine， Taizhou Hospital of Zhejiang Province， Linhai   317000， China; 2.Pediatric Intensive Care Unit， Taizhou Hospital of Zhejiang Province， Linhai   317000， China

[Abstract] Objective To investigate the relationship between behavioral scale and prognosis of patients with disorders of consciousness（DOC） in ICU. Methods Patients with disturbance of consciousness who were treated in our hospital from January to December 2018 were enrolled. According to the follow-up GOS score， the patients were divided into good prognosis group with 39 patients and poor prognosis group with 29 patients. The general and clinical data， CRS-R scores and EEG results between two groups were compared. Multivariate analysis was used to analyze factors that influenced the prognosis of patients. The correlation between the GRS-R score and the GOS score was analyzed. Results （1）After 3 months of follow-up， 39 cases recovered well， accounting for 57.35%， and 29 cases recovered badly， accounting for 42.65%. （2）Good prognosis group had significantly higher CRS-R scores than poor prognosis group. The proportion of EEGⅠ～Ⅱ in good prognosis group was significantly higher than that of poor prognosis group（P<0.05）. （3）Multivariate analysis showed that CRS-R score and EEG were the relevant factors influencing the prognosis of patients with Doc in ICU（OR=8.712， 5.709， P<0.05）. （4）There was a significant positive correlation between CRS-R score and GOS score（r=0.903）. Conclusion The prognosis of patients with DOC in ICU ward is closely related to the CRS-R score and EEG results at admission. Clinically， CRS-R score and EEG examination can make a preliminary judgment on the patient's condition and prognosis at admission.

[Key words] Coma recovery scale; ICU; Disturbance of consciousness; Prognosis

ICU病房患者多病情危重，甚至意识障碍（Disorders of consiousness，DOC）。意识是中枢神经系统对来自于内、外环境的各种刺激的应答能力，包括觉醒状态和正常的意识内容，是双层大脑皮层功能活动的综合，取决于大脑皮层功能的完整性及意识开关系统的正常与否。意识障碍是因颅脑疾病或严重全身性疾病损伤大脑皮层及皮层下脑干网状系统，导致这种应答能力减退或消失。慢性意识障碍包括微意识障碍与植物状态，而不同的状态预后有显著的差异。临床上判断患者的意识障碍情况，对判断预后具有重要的临床意义[1-3]。昏迷恢复量表（修订版）可在床旁操作，是目前广泛应用于临床的严重意识障碍患者诊断性评定以及结局评估的神经行为评定量表[4-5]。本文分析昏迷恢复量表与ICU病房DOC患者预后的关系，以期为临床诊断提供参考，现报道如下。……