Objective To explore the factors that affect the recovery of consciousness in patients with disorders of consciousness following brain trauma.Methods We analyzed the data of 114 patients with disorders of consciousness following brain trauma admitted for rehabilitation.Bilateral logistic regression analysis was used to explore the factors that affected the recovery of the patients' consciousness.A logistic regression model was established and the ROC curve was drawn to obtain the optimal threshold of the prognostic model.Results Univariate analysis showed that vegetative state duration (P＜0.001),CRS-R scores (P＜0.001),hydrocephalus (P=0.037),hypertonia (P=0.034),central fever (P=0.035),paroxysmal sympathetic hyperactivity (PSH) (P=0.004),and epilepsy seizures were correlated with the recovery of consciousness.Logistic multivariate analysis showed that central fever (OR=3.493,P=0.044),vegetative state duration (OR=1.016,P=0.008),PSH (OR=4.223,P=0.034) and CRS-R scores (OR=0.640,P=0.002) all significantly affected the recovery of consciousness.The x2 value of the Hosmer-Lemeshow test was 10.214 (P=0.250),and the goodness of fit of this model indicated an outstanding fitting (c=0.91).Conclusions The presence of PSH is the one of the most important factor followed by centric fever to affect the outcome of patients with disorders of consciousness.A lower CRS-R score and a longer duration of vegetative state also predict a poor recovery of consciousness in these patients.%目的 探讨脑损伤后意识障碍患者意识恢复的影响因素.方法 回顾性分析114例脑损伤后意识障碍患者临床资料,采用二元Logistic回归法对可能影响意识恢复的因素进行分析并建立回归模型,绘制ROC曲线,确定预后模型的最佳临界值.结果 单因素分析结果显示植物状态持续时间(P＜0.00l)、入院时昏迷恢复量表(CRS-R)评分(P＜0.001)、脑积水(P=0.037)、肌张力高(P=0.034)、中枢性发热(P=0.035)、阵发性交感神经过度兴奋(P=0.004)与意识恢复相关.Logistic回归分析显示中枢性发热(OR=3.493,P=0.044)、植物状态持续时间(OR=1.016,P=0.008)、阵发性交感神经过度兴奋(OR=4.223,P=0.034)及入院时CRS-R评分(OR=0.640,P=0.002)是意识恢复的独立影响因素.该模型Hosmer-Lemeshow检验的x2值为10.214(P=0.250),预测概率ROC曲线下面积为0.91,提示该模型拟合优度很好.结论 阵发性交感神经过度兴奋的出现是影响意识障碍患者意识恢复的首要因素;中枢性发热的出现,入院时CRS-R评分较差,植物状态持续时间过长是影响意识恢复的次要因素.
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