闪光视觉诱发电位对颅内压变化的评估作用(英文)

Evaluative effects of flash visual evoked potential on the changes of intracranial pressure

背景:闪光视觉诱发电位(flashvisualevokedpotential,fVEP)可以反映从视网膜到枕皮质视通路的完整性,应用其特征可以准确评价视传导通路受损状况。目的:研究fVEP无创监测颅内压的可行性及其效应。设计:以患者为研究对象,重复测量设计。对象:2002-03/2003-10重庆医科大学附属第一医院及首都医科大学宣武医院脑损伤患者,共197例,男138例,女59例,平均年龄(38±9)岁。病种包括:脑硬膜外血肿20例、脑硬膜下血肿26例、脑挫裂伤4例、脑硬膜下血肿伴脑挫裂伤92例、脑挫裂伤伴脑内血肿55例。方法:采用fVEP与脑硬膜外测压法检测197例脑损伤患者颅内压水平,有创检测数据均在fVEP完成后立即采集,同时记录患者血压及心率变化。主要观察指标:fVEP结果,颅内压水平。结果:197例脑损伤患者平均颅内压水平(2.75±0.64)kPa(1.54～4.02kPa);有明确视通路损伤患者无创与有创检测值离散度较大;2.79%的患者fVEP未诱发出典型波形;散点图提示fVEP与脑硬膜外测压法一致性较好;线性回归分析显示心率对颅内压水平的波动最敏感(β值为-0.369),其次是收缩压(β值为0.316),舒张压较不敏感(β值为0.147)。心率与颅内压水平呈负相关,能较敏感地反应颅内压的波动,其次为收缩压,舒张压较不易受颅内压变化的影响。结论:fVEP无创颅内压检测值?

BACKGROUND:Flash visual evoked potential(fVEP) can reflect the integrity of visual pathway from retina to pulvinar cortex. The utilization of its characters can accurately evaluate the injury situation of visual conduction pathway.OBJECTIVE:To investigate the feasibility and effects of fVEP on non- traumatic monitoring of intracranial pressure.DESIGN:A repeated measurement design based on patients.PARTICIPANTS:Totally 197 patients with brain injury including 138 males and 59 females with an average of(38± 9) years old were selected from the First Affiliated Hospital of Chongqing Medical University and Xuanwu Hospital Affiliated to Capital University of Medical Sciences.The selected diseases were: epidural hematoma(n=20),subdural hematoma(n=26),cerebral contusion(n=4), subdural hematoma companied with cerebral contusion(n=92), and cerebral contusion companied with intracerebral hematoma(n=55).METHODS:The level of intracranial pressure of 197 patients with brain trauma was detected with fVEP and epidural manometry.Data of traumatic surveillance were collected after the completion of fVEP.Changes of blood pressure and heart rate in patients were recorded simultaneously. MAIN OUTCOME MEASURES:fVEP results, and levels of intracranial pressure.RESULTS:The average intracranial pressure of 197 patients with brain trauma was(2.75± 0.64) kPa,(1.54- 4.02 kPa).The dispersion of both traumatic and non- traumatic surveillance was relatively big in patients with confirmed visual pathway injury.No typical wave was induced by fVEP in 2.79% of patients.Scatter diagram suggested that the consistence between fVEP and epidural manometry was relatively good.Linear regression analysis showed that heart rate was the most sensitive one to the fluctuation of intracranial pressure(β =- 0.369) followed by systolic pressure(β = 0.316),while diastolic pressure was not so sensitive(β =0.147).There was negative correlation between heart rate and intracranial pressure,which could quite sensitively reflect the fluctuation of intracranial pressure,systolic pressure was the next,and diastolic pressure was not easily to be affected by the changes of intracranial pressure.CONCLUSION:Non- traumatic surveillance,fVEP,has favorable consistence with traumatic detection,which can quantitatively evaluate the changes of intracranial pressure non- traumatically.