心肺复苏后昏迷患者脑电图模式对预后的预测

Electroencephalographic patterns and prediction of outcome in comatose survivors after cardiopulmonary resuscitation

目的探讨心肺复苏后昏迷患者脑电图评估时间和脑电图模式对预后预测的价值。方法选择64例心肺复苏后昏迷患者行脑电图评估。按首次脑电图监测时间段将患者分为1～3d、4～7d及〉7d监测组。脑电图监测包括全面抑制、爆发-抑制、α／θ昏迷和慢波增多四个模式，临床预后（格拉斯哥预后评分）以6个月为终点。分别统计四个脑电图模式在三个时间段内预测预后的敏感性、特异性、阳性预测值、假阳性率及总符合率。结果心肺复苏后脑电图全面抑制模式在7d内预测预后不良敏感性（67％～80％）、特异性（100％）较高；爆发-抑制模式在7d内预测预后不良特异性高（100％），但敏感性（6％～8％）低；α／θ昏迷模式预测预后不良敏感性为3％～40％、特异性为50％～67％；慢波增多在7d内预测预后良好敏感性（100％）、特异性（91％～94％）均高。结论心肺复苏后早期（7d内）脑电图显示全面抑制和爆发-抑制模式预测预后不良准确、可靠；慢波增多模式预测预后良好准确、可靠；α／θ昏迷模式预测预后不良的准确性和可靠性有限。

Objective To explore the opportunity of electroencephalographic （EEG） evaluation and the prognostic value of the EEG patterns in comatose survivors after cardiopulmonary resuscitation （CPR）. Methods Sixty-four comatose survivors were selected for EEG evaluation after CPR. According to the time intervals of the first EEG monitoring, the patients were divided into 1-3 day, 4-7 day, and 〉7 day groups. The EEG monitoring included generalized suppression, burst-suppression, alpha or theta coma, and slow wave increase patterns. The endpoint of clinical outcome （Glasgow Outcome Scale score） was evaluated at 6 months. The 4 types of EEG patterns were calculated respectively, and the prognostic sensitivity, specificity, positive predictive value, false positive rates, and total consistent rates during the 3 time intervals were predicted. Results The generalized suppression pattern had a higher sensitivity （67% -80% ） and specificity （ 100% ） in predicting unfavorable prognosis within 7 days after CPR; the burst suppression pattern had a higher specificity （ 100% ） in predicting unfavorable prognosis within 7 days, however, its sensitivity was low （6% -8% ） ; The slow wave increase pattern had high sensitivity （ 100% ） and specificity （91% -94% ） in predicting favorable prognosis within 7 days; and the sensitivity was 3% -40% , and specificity was 50% -67% in predicting unfavorable prognosis in the alpha or theta coma pattern. Conclusion The early （within 7 days） EEG after CPR may accurately and reliably show that both the generalized suppression and burst-suppression patterns predict the unfavorable prognosis; the slow wave increase pattern can accurately and reliably predict favorable prognosis; and the alpha or theta coma pattern cannot favorably predict prognosis.