【ISC2015】卒中幸存者出现危险驾驶错误的可能性更大

纳什维尔——2015国际卒中大会（ISC2015）上发布的两项加拿大小型研究显示，出现卒中后不久的司机与未出现卒中的司机相比，在进行复杂的驾驶任务时更可能出现错误。

在加拿大多伦多圣·迈克尔医院做研究的多伦多大学硕士研究生Megan A. Hird（B.Sc.）是其中一项摘要的领衔作者；她说：“目前的指南推荐，患者在卒中后至少1个月内避免驾车。然而，许多患者在1个月内重新开始驾车，并且仅有少数患者报告在卒中发生后医生立即给出驾车建议。”

Hird及同事（摘要TP123）研究了10例轻度缺血性卒中患者在卒中发生后7日内驾驶表现，对照组包括10位年龄和教育背景均相似的未出现卒中的个体。应用驾驶模拟技术，受试者完成了数项驾驶任务，包括常规的右、左转以及在车流中左转，大多数事故是在这种对司机要求苛刻的情况下发生；驾驶任务还包括巴士追随，这需要持续的专注。

他们发现：

·卒中幸存者所犯错误是未发生卒中者的2倍。

·在车流中左转时，卒中幸存者比未发生卒中者出现的错误更多；而在巴士追随任务中，前者出现错误的可能性是后者的四倍。

Herd说：“驾驶是一个复杂的多方面任务。我们的研究表明，即使是轻度病变也可能导致患者出现驾驶功能受损，尤其是当驾驶任务对认知能力要求苛刻时。卒中后患者驾驶表现的特点需要更多研究进一步阐明，这样医疗保健专业人员则可更好地评估此类患者何时恢复驾驶才保证安全。”

加拿大多伦多圣·迈克尔医院的另一项研究（摘要W MP54）回顾了一种出血性卒中，即蛛网膜下腔出血患者的驾驶表现。研究者应用了驾驶模拟技术比较了9位三个月之前出现此类卒中的功能独立的患者与9位健康的志愿者的驾驶表现。蛛网膜下腔出血卒中是一种脑基底部出血导致的卒中。

这项研究的领衔作者Kristin A. Vesely（B.Sc.）也是圣·迈克尔医院和多伦多大学的硕士研究生，她说：“很早之前我们就已知道，蛛网膜下腔出血患者即使恢复良好，其思考、决策和功能性缺陷也会持续存在，但是研究者和临床医生尚不明确这些障碍对真实世界中的活动（如驾车）会产生怎样的影响。”

他们发现蛛网膜下腔出血患者会出现更多危险的错误：

·模拟驾驶情况下，蛛网膜下腔出血患者出现碰撞的次数是其对照者的两倍，且其驶出道路标志线的可能性是后者的三倍。

·在进行最具心智挑战性的驾驶操作时，他们出现的错误更多，这些操作包括左转弯和在迎面有车流驶近时进行左转弯。但是他们在进行简单右转弯时的表现并不比健康的驾驶者差。

·健康受试者的错误主要是超速驾驶。

Vesely 说：“现行的评估患者驾驶能力的医生指南并未提供客观的、可在办公室应用的评估工具，用以鉴别不安全的驾驶者。未来的研究应在更大的蛛网膜下腔出血患者群体中探索其驾驶能力，以便明确如何向卒中后患者给出合适的驾驶建议。我们需要理解哪种临床特点可帮助预测特定驾驶障碍，这样可为可能恢复安全驾驶能力的卒中患者开发出更具针对性的评估项目和康复项目。”

这两项研究项目均有加拿大心脏和卒中基金会的支持，其中T P123还有安大略省研究与创新部的额外资金支持。

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NASHVILLE, Tenn., Feb. 11, 2015 – Drivers who have had recent strokes are more likely than drivers who have not had strokes to make errors during complex driving tasks, according to two small Canadian studies presented at the American Stroke Association’s International Stroke Conference 2015.

 “Current guidelines recommend that patients should refrain from driving for a minimum of one month after stroke. However, many patients resume driving within the one-month period after stroke, and few patients report receiving driving advice from a physician immediately post-stroke,” said Megan A. Hird, B.Sc., lead author of one of the abstracts and a master’s student at University of Toronto doing research at St. Michael’s Hospital, Toronto, Canada. 

Hird and colleagues (abstract TP123) compared the driving performance of 10 mild ischemic stroke patients, within seven days of a stroke, to 10 people similar in age and education who had not had stroke. Using driving simulation technology, participants completed several driving tasks, from routine right and left turns to more demanding left turns with traffic, where most accidents occur, and a bus following task, requiring sustained attention.

They found:

Stroke survivors committed more than twice as many driving errors. Stroke survivors had more errors during left turns with traffic and were almost four times more likely to make driving mistakes during the bus following task.

“Driving is a complex and multifaceted task,” Hird said. “Our study suggests that even patients with mild deficits may experience driving impairment, particularly during more cognitively demanding driving situations. More research is required to better characterize the driving performance of patients after stroke, so that healthcare professionals can better assess when it’s safe for stroke patients to resume driving.”

In another St. Michael’s Hospital, Toronto, Canada study, researchers reviewed the driving performance of patients who had suffered a type of bleeding stroke known as subarachnoid hemorrhages (abstract W MP54). Researchers used driving simulation technology to compare the driving performance of nine functionally independent subarachnoid hemorrhage patients, who had their strokes more than three months prior, to nine healthy volunteers. Subarachnoid hemorrhage is a stroke caused by bleeding at the base of the brain.

·“We’ve long known that thinking, decision-making and functional limitations persist despite good recoveries among patients who suffer subarachnoid hemorrhage, but researchers and clinicians do not yet understand how these impairments impact real-world activities, such as driving a car,” said Kristin A. Vesely, B.Sc., study lead author and master’s student at the University of Toronto and St. Michael’s Hospital.

They found subarachnoid hemorrhage patients made a greater number of hazardous errors:

Subarachnoid hemorrhage patients had more than twice the number of collisions in simulated driving conditions and were three times more likely to drive outside road lines. They made more errors during the most mentally-demanding driving maneuvers, including making left turns and left turns with oncoming traffic. But they did not perform worse than healthy drivers at making simpler right turns. Errors by healthy participants were primarily due to driving above the speed limit.

 “Today’s physician guidelines for assessing these patients’ driving ability do not provide objective, office-based assessment tools to help physicians identify unsafe drivers,” Vesely said. “Future studies should explore driving ability in a larger group of subarachnoid hemorrhage patients, to more clearly determine driving recommendations post-stroke. We need to understand which clinical characteristics can help predict certain driving impairments, leading to more targeted assessment and rehabilitation programs for individuals who may be able to safely resume driving.”

Both research projects were funded by the Heart and Stroke Foundation of Canada with additional funding for T P123 from the Ontario Ministry of Research and Innovation.

Copyright © 2015 Elsevier Inc. All rights reserved.