脑电图、经颅多普勒超声、体感诱发电位检测对昏迷患者脑功能评判的价值

Value of EEG,TCD and SEP on evaluating brain function in coma patients

目的探讨脑电图(EEG)、经颅多普勒超声(TCD)、体感诱发电位(SEP)检测对昏迷患者脑功能评判的价值。方法采用EEG、TCD、SEP3种检测方法,对72例昏迷患者(浅昏迷12例,中度昏迷17例,睁眼昏迷4例,深昏迷39例)进行检测脑功能并评分。结果首次检测EEG25例呈电静息、TCD28例无血流信号、SEP26例P14皮质电位消失,均在深昏迷组。复查EEG时17例最终为电静息;另有24例TCD具有振荡波、钉子波频谱改变。脑功能评分:EEGV级42例、Ⅳ级10例、Ⅲ级14例;TCDV级28例、Ⅳ级9例、Ⅲ级6例、Ⅱ级9例;SEPⅢ级27例。死亡28例及多种原因放弃治疗的25例患者以深昏迷组为多。结论昏迷程度越深,EEG、TCD、SEP分级越高,预后越差;EEG、TCD、SEP检测对评价昏迷患者脑功能状态、预测预后提供了客观、可靠的依据。

Objective To investigate the value of electroencephalogram （EEG）, transcranial Doppler sonography （TCD）, somatosensory evoked potentials （SEP） on evaluating brain function in coma patients. Methods The brain function in 72 cases of coma（ mild coma 12, moderate coma 17, open eyes coma 4 and severe coma 39 cases ） were examined using EEG, SEP , TCD and scored. Results For the first time of exam, the results of EEG in 25 cases were electrical silence; no blood stream signalthe were found in 28 cases by TCD; the wave of P14 were disappeared in 26 cases by SEP and all of them belonged to severe coma group. For the second time exam, the results of finally EEG in 17 cases were electrical silence. The results of TCD in other 24 cases were surge waves and nail waves spectra eumorphism. Brain function grading ： the EEG grade V in 42 cases, grade Ⅳ in 10 cases, grade Ⅲ in 14 cases were affirmed; TCD grade V in 28 cases, grade Ⅳ in 9 cases and SEP grade Ⅲ in 27 cases were affirmed. All the 28 cases of death and the most of 25 cases abandoned treatment for many reasons were belong to severe coma group. Conclusions The more severe of coma, the higher grade of EEG, TCD and SEP, the worse of prognosis. EEG, SEP, TCD testing can provide an objective indicator not only for evaluating brain function of coma patients, but aslo for estimating prognosis.