摘要目的:探析不同致伤机制脑损伤性意识障碍的转归。方法:选择2016年1月至2021年5月在南京紫金医院接受治疗的130例脑损伤后意识障碍患者作为研究对象，按照致意识障碍病因将患者分为4组：脑血管意外组（37例）、脑外伤组（68例）、缺血缺氧性脑病组（7例）、脑动脉瘤组（18例）。4组患者均予以高压氧、电刺激、针灸、被动训练、药物治疗等综合治疗，比较4组患者治疗前及高压氧综合治疗3个月后的格拉斯哥昏迷量表（GCS）评分和中国南京持续性植物状态量表（CNPVSS）评分，比较4组患者在高压氧综合治疗3个月后的意识转清率和总体疗效。结果:高压氧综合治疗3个月后，4组患者的GCS评分及CNPVSS评分均升高（ P<0.05），脑动脉瘤组GCS评分及CNPVSS评分提升最显著；意识转清率最高的是脑血管意外组（64.86%，24/37），其次是脑动脉瘤组（55.56%，10/18），4组间意识转清率差异有统计学意义（ P<0.01）；总体治疗疗效转归依次为脑血管意外组、脑动脉瘤组、脑外伤组及缺血缺氧性脑病组，治疗总有效率分别为86.49%（32/37）、83.33%（15/18）、69.12%（47/68）、42.86%（3/7），差异有统计学意义（ P<0.05）。脑血管意外组和脑动脉瘤组在经过3个月高压氧综合治疗后的意识转清率和意识障碍的好转有效率均好于其他2组。 结论:不同致伤机制脑损伤性意识障碍在转归上存在差异。

abstractsObjective:To explore the therapeutic outcome of consciousness disorders induced by different brain injury mechanisms.Methods:A total of 130 patients with impaired consciousness after brain injuries treated in Nanjing Zijin Hospital from January 2016 to May 2021 were taken as research subjects. According to the causes of injury，they were divided into cerebrovascular accident group（ n = 37），brain trauma group（ n=68），hypoxic-ischemic encephalopathy group（ n = 7），and cerebral aneurysm group（ n = 18）. The patients in the four groups were all given comprehensive treatment，including hyperbaric oxygen（HBO）therapy，electrical stimulation，acupuncture，passive training，and drug therapy. The Glasgow Coma Scale（GCS）scores and China Nanjing persistent vegetative state scale（CNPVSS）scores of the four groups before treatment and after three months of comprehensive treatment combined with HBO were compared，and the consciousness recovery rate and the overall curative effect of the four groups were also compared. Results:After three months of comprehensive treatment combined with HBO，the GCS scores and CNPVSS scores of the four groups were improved compared with those before treatment（all P < 0.05）；the most significant increase of GCS scores and CNPVSS scores was in the cerebral aneurysm group. The highest consciousness recovery rate was in the cerebrovascular accident group（64.86%，24/37），followed by cerebral aneurysm group（55.56%，10/18），and there were statistically significant differences in the consciousness recovery rate among the four groups（ P < 0.01）. The overall effective rate was in the descending order of cerebrovascular accident group［86.49%（32/37）］，cerebral aneurysm group［83.33%（15/18）］，brain trauma group［69.12%（47/68）］，and hypoxic-ischemic encephalopathy group［42.86%（3/7）］，with statistically significant differences（ P < 0.05）. The cerebrovascular accident group and the cerebral aneurysm group achieve higher consciousness recovery rates and greater improvement in consciousness disturbance compared with the other two groups after three months of comprehensive treatment combined with HBO. Conclusion:Different injury mechanisms affect the therapeutic outcomes of consciousness disorders induced by brain injuries.