脑损害昏迷患者脑状态实时监测的研究及应用

Study and application of cerebral state monitor evaluating coma in cases with brain injury

目的评价脑状态指数(cerebral state index,CSI)、肌电指数(electromyogmphic,EMG)、爆发抑制指数(burst suppression,BS)等指标在量化昏迷深度及监测脑功能损害程度中的作用。方法对50例临床脑损害昏迷患者进行脑状态监测(cerebral stale monitor,CSM),分析这些指标与患者的体征反射、听觉诱发电位(AEP)、格拉斯哥昏迷评分(GCS)及格拉斯哥预后评分(GOS)改变的关系。结果CSI 0～100是从清醒到深昏迷、脑死亡一个连续不断的刻度范围,与患者昏迷深度确切相关,与GCS、体征反射相应消涨；在恒定刺激作用下的CSI变化,结合BS、EMG能够准确判断患者预后,量化脑功能的改变并赋予其相应的临床意义。结论通过CSM获得量化的、数字化的脑功能损害程度,可以实时判定昏迷深度及昏迷动态演变过程,客观地指导临床救治和把握预后,根本改善了根据临床表现来评定所存在的明显的人为差异、缺少客观物证的昏迷及预后评分的现状。

Objective To evaluate the role of cerebral state index （CSI）, burst suppression （BS） and electromyograph （EMG） in monitoring coma/consciousness depth and damage degree of brain. Methods CSM was done in 50 cases with brain injury and coma to analyze its relation with physical reflection, auditory evoked potential （AEP）, Glasgow coma score （GCS） and Glasgow outcome scale （GOS）. Results As scale range meaning from consciousness to deep coma and to brain death, CSI 0- 100 was positively correlated with coma depth, coma score of GCS and physical reflection. CSI changes under invariable ache stimulation in combination with BS and EMG can accurately estimate prognosis and quantify changes of brain function. Conclusions The quantifiable digit of coma/consciousness depth and damage degree in brain function by CSM can attain real time judgment of dynamic evolvement course of coma and objective guide clinical therapy and assure prognosis, as will change absolutely scoring coma/ consciousness depth and prognosis under current state of artificial diversity and lacking objective evi- dences.