植物人与最低意识状态的治疗综述

Brittany D. Morris, John Wong
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引用次数: 0

摘要

意识障碍(DoC),包括植物人状态,现在被称为无反应性觉醒综合征,以及最低意识状态,导致患者严重残疾,同时给医疗机构、经济和社会带来重大负担。有效的治疗策略是必要的,以减轻这些菌株,但缺乏标准化的、基于证据的治疗方案。当考虑到目前缺乏全面的范围综述文章来组织和呈现现有文献时,实现这一目标的进展仍然很困难。目前的范围综述旨在填补这一空白,同时提出了最新的综合汇编当前的治疗策略及其对植物人状态/无反应性清醒综合征和最低意识状态的疗效。为了实现这一目标,使用PubMed数据库对2011年至2021年之间的现有文献进行了检查,以汇编和展示当前的治疗策略及其在植物人状态/无反应性觉醒综合征和最低意识状态患者中的疗效。在收集到的112篇文章中,32篇报道了成功的治疗,69篇报道了治疗的一些增量益处,11篇没有发现治疗的益处。总的来说,感觉刺激、经颅直流电刺激、经颅磁刺激、脊髓刺激、迷走神经刺激、康复计划、颅骨成形术以及唑吡坦、金刚烷胺、巴氯芬、咪达唑仑和氯硝西泮等药物治疗结合神经康复治疗与DoC的成功治疗相关。考虑到与DoC相关的个人、社会和经济负担,有必要进一步研究以确定和制定循证策略,以有效治疗DoC患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A scoping review of treatments for the vegetative and minimally conscious states
Disorders of consciousness (DoC) including the vegetative state, now known as unresponsive wakefulness syndrome, and the minimally conscious state lead to profound disability among affected individuals while placing a major burden on health care facilities, the economy, and society. Efficacious treatment strategies are necessary to alleviate these strains, but standardized, evidence-based protocols for the treatment of DoC are lacking. Progress towards this end remains difficult when considering the current dearth of comprehensive scoping review articles to organize and present the existing literature. The present scoping review seeks to fill this gap while presenting an up-to-date comprehensive compilation of current treatment strategies and their efficacy for vegetative state/unresponsive wakefulness syndrome, and minimally conscious state. To accomplish this, an examination of the existing literature between 2011 and 2021 was conducted using the PubMed database to compile and present current treatment strategies and their efficacy amongst patients in vegetative state/unresponsive wakefulness syndrome and minimally conscious state. Of the 112 articles collected, 32 reported successful treatment, 69 reported some incremental benefits of treatment, and 11 identified no benefit of treatment. Overall, sensory stimulation, transcranial direct current stimulation, transcranial magnetic stimulation, spinal cord stimulation, vagus nerve stimulation, rehabilitation programs, cranioplasty, and pharmacological treatments with zolpidem, amantadine, baclofen, midazolam, and clonazepam dose reduction coupled with neurorehabilitation were associated with successful treatment of DoC. Given the personal, societal, and economic burden associated with DoC, further research is warranted to determine and protocolize evidence-based strategies for effective treatment of those with DoC.
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