昏迷患者脑电图反应性对预后的预测价值

Prognostic predictive value of EEG reactivity in comatose patients

目的：探讨脑电图（EEG）的反应性对昏迷患者预后的预测价值。方法：52例昏迷患者行床边动态EEG记录，判定刺激后EEG反应性。根据Synek分级（1988）将EEG类型进行预后分类。观察终点为患者发病3个月后存活情况。对患者EEG反应性及相关临床数据特点与预后结果进行单因素和多因素logistic回归分析。结果：在EEG记录中，有反应者生存率为90％。无反应者生存率28．6％。在Synek分级为预后不确定的患者中，EEG有反应者12例，生存率为92％；无反应性的6例，生存率为33％。单因素分析结果示格拉斯哥昏迷量表（GCS）评分、Synek分级和EEG反应性与预后有关（均P〈O．01）。EEG反应性对判定预后的敏感性为83％，特异性为82％。多因素logistic回归分析显示，入院时EEG反应性EOR=0．019，95％CI（0．001，0．291）]、GCS评分及Synek分级与预后显著相关。结论：EEG反应性对昏迷患者具有很好的预测价值。

Objective： To study the prognostic predictive value of EEG reactivity in comatose pa- tients. Methods： EEG was dynamically recorded at bedside in 52 comatose patients EEG reaction to stim- uli. EEG was classified according to Synek classification （1988）. The prognosis（death or survival）was e- valuated at 3 months after the onset. Univariate analysis and multivariate logistic regression analysis were performed on EEG reactivity and clinical data of prognosis. Results.. In patients with reactivity, 900//00 of them survived, while in patients without reaction,29% survived. EEG reactivitis were detected in 67% of patients classified ＇ uncertain＇ and 92 % of them survived at 3 months after the onset. Univariate anal- ysis showed the EEG reactivity, GCS score and Synek classification were correlated significantly with prognosis（all P〈0.01）. The rate of sensitivity and specificity of EEG reactivity were 83% and 82% re- spectively. Multivariate logistic regression analysis demonstrated that the EEG reactivity [-OR= 0. 019, 95 % CI（0. 001,0.291） ], GCS score and Synek classification were correlated significantly with prognosis. Conclusion： EEG reactivity is an excellent outcome predictor in comatose patients.