الگوهاي شناختي بيماران كما ناشي از آسيب مغزي تروماتيك شديد در حافظه كاري

Cognitive Patterns of Coma Patients Induced by Severe Traumatic Brain Injury in Working Memory

زﻣﯿﻨﻪ و ﻫﺪف: ﮐﻤﺎ ﻧﺎﺷﯽ از آﺳﯿﺐ ﻣﻐﺰي ﺗﺮوﻣﺎﺗﯿﮏ ﺷﺪﯾﺪ، ﻣﻨﺠﺮ ﺑﻪ اﺧﺘﻠﺎل ﻋﻤﻠﮑﺮد ﺷﻨﺎﺧﺘﯽ ﻣﯽﺷﻮد ﮐﻪ ﺑﯿﺸﺘﺮﯾﻦ ﺗﺎﺛﯿﺮ آن ﺑﺮ ﺣﺎﻓﻈﻪ ﮐﺎري اﺳﺖ. ﺑﺪﻟﯿﻞ اﻫﻤﯿﺖ و ﺗﺎﺛﯿﺮ ﻣﺴﺘﻘﯿﻢ ﺣﺎﻓﻈﻪ ﮐﺎري ﺑﺮ ﮐﯿﻔﯿﺖ زﻧﺪﮔﯽ اﻧﺴﺎن، ﺑﻮﯾﮋه در ﻣﻬﺎرتﻫﺎي ﻧﻈﺎﻣﯽ ﮐﻪ ﻧﯿﺎز ﺑﻪ ﺣﺎﻓﻈﻪ ﻓﻌﺎل و ﻗﺪرت ﺗﻮﺟﻪ ﺑﺎﻟﺎ دارد؛ ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺎ ﻫﺪف ﺑﺮرﺳﯽ اﻟﮕﻮﻫﺎي ﺷﻨﺎﺧﺘﯽ ﺑﯿﻤﺎران ﮐﻤﺎ در ﺣﺎﻓﻈﻪ ﮐﺎري اﻧﺠﺎم ﺷﺪ. روشﻫﺎ: در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻣﻘﺎﯾﺴﻪاي ﮐﻪ در ﻓﺎﺻﻠﻪ زﻣﺎﻧﯽ ﺑﻬﻤﻦ 1396 ﺗﺎ ﺗﯿﺮ 1398 اﻧﺠﺎم ﮔﺮﻓﺖ. 20 ﺑﯿﻤﺎر ﻣﺮد ﮐﻤﺎ، ﺑﺎ داﻣﻨﻪ ﺳﻨﯽ 30 ﺗﺎ 55 ﺳﺎل ﮐﻪ ﯾﮑﺴﺎل از ﺑﺮﮔﺸﺖ آﻧﺎن از ﮐﻤﺎ ﮔﺬﺷﺘﻪ ﺑﻮد و ﻃﯽ ﯾﮑﺴﺎل ﮔﺬﺷﺘﻪ در ﺑﺨﺶ ICU ﺑﯿﻤﺎرﺳﺘﺎﻧﻬﺎي ﺷﻬﺪاي ﻫﻔﺘﻢ ﺗﯿﺮ ﺷﻬﺮري و ﺑﻘﯿﻪاﻟﻠﻪ)ﻋﺞ( ﺗﻬﺮان ﺑﺴﺘﺮي ﺑﻮدﻧﺪ، ﺑﻌﻨﻮان ﮔﺮوه آزﻣﺎﯾﺸﯽ و 64 ﻣﺮد ﺳﺎﻟﻢ ﺑﺎ داﻣﻨﻪ ﺳﻨﯽ ﻫﻤﺘﺎ ﺑﻌﻨﻮان ﮔﺮوه ﮐﻨﺘﺮل ﺑﺎ روش ﻧﻤﻮﻧﻪﮔﯿﺮي در دﺳﺘﺮس اﻧﺘﺨﺎب ﺷﺪﻧﺪ. اﯾﻦ اﻓﺮاد ﺑﺎ آزﻣﻮن ﺣﺎﻓﻈﻪ ﮐﺎري وﮐﺴﻠﺮ ﻣﻮرد ارزﯾﺎﺑﯽ ﻗﺮار ﮔﺮﻓﺘﻨﺪ. ﻣﻘﺎﯾﺴﻪ ﻋﻤﻠﮑﺮد دو ﮔﺮوه ﺑﺎ اﺳﺘﻔﺎده از آزﻣﻮن ﺗﺤﻠﯿﻞ وارﯾﺎﻧﺲ ﭼﻨﺪ راﻫﻪ اﻧﺠﺎم ﺷﺪ. ﯾﺎﻓﺘﻪﻫﺎ: ﺗﻔﺎوت دو ﮔﺮوه در زﯾﺮﻣﻮﻟﻔﻪ ﻓﺮاﺧﻨﺎي ﺣﺎﻓﻈﻪ دﯾﺪاري از ﻧﻈﺮ آﻣﺎري ﻣﻌﻨﺎدار ﺑﻮد 0/05

Background and Aim: Coma caused by severe traumatic brain injury, leads to cognitive function disorder, the most frequently affects being on the working memory. Because of the importance and direct impact of working memory on the quality of human life, especially in military skills that require active memory and high attentional power; the present study aimed to investigate the cognitive patterns of patients coma in working memory. Methods: In this causal-comparative study, which was conducted from February 2017 to July 2019, two groups of individuals were selected by available sampling method. 20 comatose patients, aged 30-55 years, who had returned from coma during last year and were admitted to ICU ward of Haft-e-Tir and Baqiyatallah hospitals in Tehran, Iran, were included as the experimental group and 64 healthy individuals with the same age range considered control group. All participants were male and were assessed by Wechsler working memory. The performance of the two groups was compared using multivariate analysis of variance. Results: The difference between the two groups in the visual memory span was statistically significant (p <0.05) and the difference between the two groups in other subdomains of working memory test were statistically significant (p <0.01). In general, coma patients showed a poorer performance than the healthy group. Conclusion: Coma caused by severe traumatic brain injury, can disturb executive functions of the brainchr('39')s prefrontal lobes after one year and impair patientschr('39') working memory. Hence, it is strongly suggested that in clinical and legal evaluations of the patients, this issue to be considered and both psychological and medical interventions done simultaneously to facilitate the treatment process and cognitive rehabilitation of the patients and to prevent individual, social and financial consequences and costs associated with a coma