神经电生理在昏迷预后评估中的应用

PREDICTIVE VALUE OF NERVE ELECTROPHYSIOLOGY IN COMATOSE PATIENTS

目的探讨动态脑电图(AEEG)、脑干听觉诱发电位(BAEP)和体感诱发电位(SEP)监测在昏迷预后评估中的应用。方法对60例昏迷患者进行AEEG、BAEP和SEP监测,AEEG按照Young的分级方法分为5级,参照杨柏捷的分级方法将BAEP分为3级,参照Cant的分级方法将SEP分为3级,并与患者3个月后的预后相比较。结果 AEEGⅠ级BAEPⅠ级SEPⅠ级患者14例,10例清醒,2例植物生存状态,2例(14.3%)死亡;AEEGⅡ级BAEPⅡ级SEPⅡ级患者15例,5例清醒,4例植物生存状态,6例(40.0%)死亡;AEEGⅢ级BAEPⅡ级SEPⅡ级患者13例,3例清醒,3例植物生存状态,7例(53.8%)死亡;AEEGⅣ～Ⅴ级BAEPⅢ级SEPⅢ级患者18例,0例清醒,1例植物生存状态,17例(94.4%)死亡。结论 AEEG、BAEP和SEP分级的高低与昏迷患者的临床预后关系密切,随着电生理级别的升高,患者病死率递升(P<0.05)。AEEG、BAEP和SEP监测在昏迷的预后评估中具有重要作用。

Objective To observe the prognostic value of ambulatory electroencephalogram（AEEG）, brainstem auditory evoked potentials（BAEP）, and somatosensory evoked potentials（SEP） in comatose patients. Methods AEEG, BAEP and SEP were examined in 60 comatose patients. The consequence was analyzed. The AEEG result was defined as Level Ⅰ-Ⅴ, BAEP and SEP results were defined as Level Ⅰ-Ⅲ. The patients were followed- up for 3 months. The endpoints for outcome were graded as conscious state, continuous vegetationl state and death. Results Forteen of 60 cases belonged to Level Ⅰ of AEEG, BAEP and SEP, in which 10 recovered well, 2 in continuous vegetationl state and 2（14.3%）death. Fifteen of 60 cases belonged to Level Ⅱ of AEEG, BAEP and SEP, in which 5 recovered well, 4 in continuous vegetationl state and 6（40.0%） death. Thirteen of 60 cases belonged to Level 111 of AEEG, level 11 of BAEP and SEP, in which 3 recovered well, 3 in continuous vegetationl state and 7（53.8%） death. Eighteen of 60 cases belonged to Level Ⅳ-Ⅴ of AEEG, level Ⅲ of BAEP and SEP, in which no one recovered well, 1 in continuous vegetationl state and 17（94.4%）death. Conclutions A close relationship between bad outcome and high level of AEEG, BAEP and SEP is found in comatose patients. Significant difference are found between the death of different nerve electrophysiology level patients （P〈0.05）. It can improve the veracity in evaluation of the outcome in comatose patients to use AEEG, BAEP and SEP.