神经电生理检查对重症脑血管病脑功能监测的影响

The effect of neurophysiological examination for cerebral function monitoring in severe cerebral vascular disease

目的:评价诱发电位、持续脑电图监测对重症脑血管病脑功能监测及预后的影响。方法:收集重症脑血管病患者48例,根据格拉斯哥(Glasgow,GCS)评分,分为重症组(GCS≤8分)和非重症组(GCS>8分)。应用丹麦维迪肌电图仪监测脑干听觉诱发电位、体感诱发电位,并根据CANT分级标准分为Ⅰ、Ⅱ、Ⅲ3级,分别比较重症组与非重组诱发电位的表现,并比较不同级别诱发电位与预后的关系;应用上海群天动态脑电图仪进行床旁持续脑电图监护,采用Young的脑电图分级标准进行分级,比较重症组、非重症组脑电图表现,并比较不同级别脑电图与预后的关系。结果:(1)重症组病死率(40.00%)明显高于非重症组(14.29%);而非重症组良好率、好转率均明显好于重症组。(2)重症组体感诱发电位、脑干听觉诱发电位表现为Ⅲ级者,明显高于非重症组(P<0.05),其病死率高,预后不良;而表现为Ⅰ级者,预后相对较好。(3)脑电图YoungⅡ级者病死率(58.83%)明显比Ⅰ级(12.90%)高,而Ⅰ级者预后相对较好。结论:持续床旁神经电生理监测可客观地评价重症脑血管病脑功能,并能预测预后,指导治疗。

Objective：To evaluate the value of combined evoked potential with continuous EEG to monitor the cases of severe cerebral vascular disease.Methods：48 cases of severe cerebral vascular disease were divided into severe or moderate groups based on the GCS（≤or8）.BAEP and SEP were used for monitoring of brain and brain stem functions.The BAEP and SEP results were divided into grade Ⅰ,grade Ⅱ and grade Ⅲ according to Cant＇s classification.Continuous EEG monitored all patients by bedsides.The EEG findings were divided into 6 grades based on Young＇s criteria.Results：（1）The mortality of the patients in the severe group was 40.00%,significantly higher than that in the group of moderate symptom（14.29%）.The survivors with good outcome accounted for 35.71% in the moderate group,much better than those in the severe group.（2）The numbers of the patients with Ⅲ grade SEP and BAEP results in the severe group were higher than those in the moderate group.The mortality of the patients with Ⅲ grade SEP and BAEP results was high and the most of survivors were found with obvious disability in outcome.The patients with gradeⅠSEP and BAEP results showed a better outcome.（3）48 patients of cerebral vascular disease were monitored with continuous EEG monitoring by bedside.The results revealed that the mortality of the patients with gradeⅡEEG results was much higher than that of the patients with gradeⅠEEG results.Conclusion：The cerebral function of patients of severe cerebral vascular disease may be estimated precisely and objectively by using continuous monitoring of SEP,BAEP and EEG at bedside,which will provide valuable information about patient＇s prognosis and treatment.