神经电生理监测对药物治疗脑外伤的评价意义

Neuroelectrophysiological monitoring of short－ term therapeutic efficacy of GM1 in patients with acute head injuries

目的探讨神经电生理监测在药物治疗急性脑外伤近期疗效评价的意义。方法对 14例中、重型脑外伤患者静脉推注神经节苷脂 (GM1) 100mg，每次用药前，后 1， 3h监测脑电地形图 (BEAM)和正中神经短潜伏期体感诱发电位 (SLSEP)。结果患者格拉斯哥昏迷评分 (GCS)从药物治疗前的 ( 8.14± 2.41)分升高至治疗后的 ( 9.57± 3.11)分 (P< 0.05)。 SLSEP的 N13～ N20峰间潜伏期 (IPL)治疗后显著缩短， N20波幅治疗后显著增高， P< 0.05。 BEAM可见δ、θ频段功率值呈下降趋势，α、β频段功率值变化不明显， (δ＋θ ) / (α＋β )比值呈下降趋势，但均无统计学意义。结论 SLSEP更适宜于急性中、重型脑外伤患者近期疗效的监测。

Objective To evaluate the neuroelectrophysiological monitoring of short－ term therapeutic efficacy in paticnts with acute head injuries.Method 14 cases of moderate and severe traumatic closed head injuries were admitted to our intensive care unit and treated with GMl ganglioside,Glasgow Coma Scale(GCS)≤ 12 before treatment.GMl 100mg was given intravenously by perfusor.Brain electric activity mapping(BEAM)and median nerve short－ latency somatosensory evoked potential(SLSEP)were recorded before and at the first and the third hours post treatment.The changes of their electophysiological parameters were analysed.Result The patients were improved after treatment,the GCS scores were increased from(8.14± 2.41)to(9.57± 3.11),P< 0.05.The N13～ N20 interpeak latency(IPL)in SLSEP was decreased significantly after treatment,the amplitude of N20 was increased significantly,P< 0.05.The average power value ofα andβ band showed no significant difference in BEAM,the average power value ofδ andθ band were decreased,(δ＋θ )/(α＋β ) was decreased,but they showed no statistical significance.Conclusion We suggested that SLSEP could effectively monitor therapeutic efficacy in patients with acute moderate and severe head injuries.