体感诱发电位在急性脑卒中后的变化观察和意义探讨

Dynamic changes of somatosensory evoked potentials in acute brain apoplexy patients

目的观察急性脑卒中患者体感诱发电位（SEP）改变特点，评价其对于脑功能监测的价值。方法对58例脑梗死、27例脑出血和11例蛛网膜下腔出血患者，检测发病后不同时期（1～12d）SEP和血清神经元特异性烯醇化酶（NSE）改变，结合中国卒中量表评分（CSS）、Barthel指数、Glasgow-Pittsburgh昏迷量表评分以及颅脑影像学检查结果，分析与临床神经功能缺失的关系。25例年龄和性别匹配的正常人作为对照。结果发病后4d内各型脑卒中患者的SEP—P15、N20、P25和P40峰潜伏期较正常对照显著延长（P〈0．01）。脑出血和脑梗死患者发病后4d内SEP异常率高于发病后5～12d测定结果。发病后4d内，幕下脑出血和后循环脑梗死患者SEP—N20峰潜伏期与其病灶大小呈正相关（P〈0．01）。脑出血和脑梗死患者SEP—N20峰潜伏期与其血清NSE水平和CSS评分呈正相关（P〈0．01）。各型脑卒中患者SEP—N20峰潜伏期与其Glasgow-Pittsburgh昏迷量表评分呈负相关（P〈0．01）。结论SEP—N20峰潜伏期异常反映脑出血和脑梗死患者脑损伤和神经功能缺失严重程度，并可作为评估蛛网膜下腔出血患者昏迷程度的指标。

Objective To observe the characteristics of dynamic changes in somatosensory evoked potential （SEP） changes and to evaluate its value in the assessment of brain function in acute brain apoplexy patients. Methods SEP and the serum neuron-specific enolase （NSE） were measured 1-12 d after the onset of apoplexy in 58 brain infarction, 27 brain hemorrhage and 11 subarachnoid hemorrhage patients. Twenty-five normal subjects matched with the patients in age and sex were used as controls. Neural function was evaluated in all patients using the test of Chinese stroke scale （CSS）, Barthel index （BI） and Glasgow-Pittsburgh coma scale. Brain imaging was made by CT scan in all patients. The relationship between changes of SEP and neural function defects in the patients was analyzed. Results The peak latency of P15, N20, P25, P40 of somatosensory evoked potential induced by the stimulation of median nerve was significantly prolonged in the apoplexy patients compared with the normal subjects （P 〈 0.01）. The peak latency of SEP- N20 was positively correlated with the score of CSS in brain hemorrhage and infarction patients （P〈 0.01） and negatively correlated with the score of Glasgow- Pittsburgh come scale in all apoplexy patients （P 〈 0.01）. Conclusions The abnormal peak latency of N20 in SEP can reflect the severity of the brain damage and of the defect in neurological function. It also can be used in the assessment of the severity of coma in SAH.