创伤性颅脑损伤患者睡眠情况与病情和功能结局的相关性

Correlations of sleep status with disease condition and functional outcome of patients with traumatic brain injury

  • 摘要:
    目的 探讨创伤性颅脑损伤(TBI)患者住院期间睡眠情况与病情严重程度和出院时功能结局的相关性。
    方法 选取90例中重度TBI患者作为研究对象, 记录患者住院期间睡眠情况和出院时功能独立性评定量表(FIM)评分情况,并根据FIM评分中位数将患者分为功能良好组和功能不良组。采用多因素线性回归分析探讨TBI患者功能不良的影响因素; 采用Spearman相关分析法分析睡眠情况与格拉斯哥昏迷评分法(GCS)评分、创伤严重程度评分(ISS)、FIM评分的相关性。
    结果 90例患者出院时FIM评分为31~79分,中位FIM评分为49分,据此将患者分为功能良好组45例和功能不良组45例; 功能良好组GCS评分、睡眠效率(SE)、平均每日睡眠时间高于或长于功能不良组,年龄、ISS低于功能不良组,差异有统计学意义(P < 0.05)。Spearman相关分析显示, SE与GCS评分呈正相关(ρ=0.591, P < 0.05), 与ISS呈负相关(ρ=-0.563, P < 0.05), 与FIM评分呈正相关(ρ=0.733, P < 0.05);多因素线性回归分析显示,低GCS评分(t=3.900)、低SE (t=2.297)、年龄大(t=-2.734)、高ISS评分(t=-2.460)是TBI患者功能不良的独立危险因素(P < 0.05)。
    结论 TBI患者病情越严重,夜间睡眠则越差,且夜间睡眠质量与出院时功能结局高度相关。

     

    Abstract:
    Objective To explore the correlations of sleep status during hospitalization of traumatic brain injury (TBI) patients with the severity of the illness as well as the functional outcome at discharge.
    Methods A total of 90 patients with moderate to severe TBI were selected as research objects, sleep condition during hospitalization and Functional Independence Rating Scale (FIM) score at discharge were recorded, and patients were divided into good function group and poor function group according to the median FIM score. Multivariate linear regression analysis was used to investigate the influencing factors of dysfunction in TBI patients. Spearman correlation analysis was used to analyze the correlation of sleep status with Glasgow Coma Scale (GCS) score, trauma severity score (ISS) and FIM score.
    Results The FIM score of 90 patients ranged from 31 to 79 points at discharge, and the median FIM score was 49 points. Based on this, they were divided into good function group (n=45) and poor function group (n=45). The GCS score, sleep efficiency (SE) and average daily sleep time of the good function group were higher or longer than those of the poor function group, while the age and ISS of the good function group were lower than those of the poor function group, and the differences were statistically significant (P < 0.05). Spearman linear correlation analysis showed that SE was positively correlated with GCS score (ρ=0.591, P < 0.05), negatively correlated with ISS score (ρ=-0.563, P < 0.05), and positively correlated with FIM score (ρ=0.733, P < 0.05). Multivariate linear regression analysis showed that low GCS score (t=3.900), low SE (t=2.297), older age (t=-2.734), high ISS score (t=-2.460) were independent risk factors for poor function in TBI patients (P < 0.05).
    Conclusion The more severe the condition of TBI patients is, the worse their sleep at night will be, and the quality of sleep at night is highly correlated with functional outcomes at discharge.

     

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