体感诱发电位头皮分布对急性脑血管病近期转归的预测价值探讨

Investigation on the value of somatosensory evoked potential scalp distribution in predicting the clinical recovery of acute cerebrovascular disease in the near future

目的初步探讨体感诱发电位头皮分布(SEPSD)对急性脑血管病(AVCD)的近期临床转归的预测价值。方法收集AVCD急性期患者39例,按照国际10～20系统在头皮装置双侧前额(Fp1,Fp2)、中额(F3,F4)、中央(C3,C4)、顶(P3,P4)、枕(O1,O2)、前颞(F7,F8)、中颞(T3,T4)、后颞(T5,T6)共16个Ag/AgCl表面电极,分别刺激患者双侧腕正中神经,记录其SEPSD,以健侧结果为参照。同时用改良爱丁堡及斯堪的纳维亚研究组评分标准在发病时、病程1个月末对ACVD患者病情严重程度进行评分,并计算临床改善程度。结果刺激健侧正中神经时除双侧前额、中额各波波幅很低外,其他各记录点50ms内SEP各波波形和极性基本一致,可见P15、N20、P25、N32、P38。AVCD患者急性期SEPSD可分成重(9例)、中(7例)、轻度异常(23例)3个等级,对应临床恢复程度(以中位数和四分位数间距表示)分别为22.45%(22.63%)、31.90%(26.10%)和67.70%(25.70%),重度和中度异常者的恢复程度均低于轻度异常者(P<0.01),3例死亡者均属重度异常。刺激同侧波形未均消失的患者和均消失的患者间病程1个月末临床恢复程度分别为65.00%(32.60%)和27.90%(18.40%),差异有统计学意义(P<0.001)。结论 SEPSD对ACVD患者近期预后有一定评估价值。刺激同侧各导联波形均消失可能预示预后不佳,但双侧各导联波形均消失是否预示预后更差尚无定论。

Objeetive To investigate the value of somatosensory evoked potential scalp distribution （SEPSD） in predicting the prognosis of acute cerebrovascular disease （AVCD） in the near future. Methods SEPSDs were obtained by 16 Ag/AgC1 scalp surface recording electrodes including Fpl, Fp2, F3, F4, C3, C4, P3, P4, O1, O2, F7, F8, T3, T4, TS, T6 set according to the international 10-20 system from 39 stroke patients at the acute stage. Their bilateral median nerves were stimulated at the wrist, and we took the result from the uninvolved side as self reference. The patients＇ clinical neurological impairments were measured by Modified Edinburgh- Scandinavian Stroke Scale （MESSS） at disease onset and 1 month later, and the extents of their improvements were calculated. Results When the uninvolved side was stimulated, P15, N20, P25, N32, P38 could be found within 50 ms. There was no difference in waveform and polarity at all recording sites except Fpl, Fp2, F3, F4, where amplitudes recorded were lower than those recorded at the other sites. When the involved side was stimulated, patients＇ SEPSD could be divided into three abnormal degrees severe （9 cases）, moderate （7 cases） and mild （21 cases）. The percentages of their clinical improvements in the form of median and interquartile distance were 22.45% （22.63%）, 31. 90% （26.10%） and 67.70V0 （25.70%） respectively, the former two were both lower than the latter （P^0.01）. All 3 died patients belonged to severe group. The clinical improvements in the patients whose SEPs recorded in scalp ipsilateral to the stimulation were all absent was significantly worse than those in the patients whose ipsilateral SEPs were not all disappeared [27.90% （18.40%） vs. 65.00% （32.60%）, P〈0.01]. Conclusions To some extent, SEPSD recorded at the acute stage of stroke have predictive values on ACVD patients＇ functional outcome in the near future. It might predict poor recovery when no wave is found at recording channels ipsilateral to the stimulation on the trouble side.However it is uncertain whether it predicts even more worse outcome when no wave is found at all 16 recording channels.