QEEG在大面积MCA供血区脑梗塞患者预后评估中的意义

The Significances of QEEG in Evaluating the Prognosis of Patients with Widespread Cerebral Infarction in the MCA Blood-supply Area

目的:探讨(定量化脑电图)QEEG在大面积(大脑中动脉)MCA供血区脑梗塞患者预后评估中的意义。方法:分析2010年2月至2013年6月在我院神级内科病房接受住院治疗的大面积MCA供血区脑梗塞患者的临床资料。根据随访时间分为近期随访(发病后1月)和远期随访(发病后3月)。近期随访根据患者的预后分为死亡组和生存组;远期随访根据预后(CPCs分级方法)分为预后不良组和预后良好组。分别比较组间患者的一般信息、临床信息(包括患者血压、血清同型半胱氨酸水平等)、GCS评分(格拉斯哥昏迷评分)、常规脑电图检测及QEEG相关参数等,并对患者的年龄、GCS评分及QEEG参数对于患者的预后价值分别行ROC曲线分析。结果:对于近期预后,生存组患者的GCS评分(t=2.348,P=0.019)和SEF95%(t=3.446,P<0.01)均高于死亡组,而δ绝对频带能量(t=2.814,P<0.01)、θ绝对频带能量(t=2.104,P=0.018)均低于死亡组,差异均有统计学意义;对于远期预后,预后良好组患者的年龄(t=2.951,P<0.01)、δ绝对频带能量(t=2.434,P<0.01)显著低于预后不良组,而良好组患者的GCS评分(t=2.963,P<0.01)、SEF95%(t=2.725,P<0.01)和aEEG上界(t=2.310,P<0.01)显著高于不良组;患者年龄、GCS评分及QEEG数据三者联合预测价值的曲线下面积为0.932,敏感性为91.80%,特异性为91.02%,明显优于三者单独对于预后的预测价值。结论:QEEG参数(如SEF95%、aEEG上界及δ绝对频带能量等)结合脑梗患者的年龄和GCS评分对于大面积MCA脑梗患者预后有着重要的预测价值。

Objective：To investigate the significances of quantitative electroencephalogram （QEEG） in evaluation of the prognosis of patients with widespread cerebral infarction in the medial cerebral artery （MCA） blood-supply area.Method：The clinical data on patients with widespread cerebral infarction in the MCA blood-supply area admitted into the department of neurology of our hospital between Feb .2010 and Jun.2013 was analyzed.The patients were short-term （in one month after the development of the disease ） or long-term （in three months after the development of the disease ） followed up.Patients with short-term followed up were divided into death group and survival group based on the prognosis of the patients ;while patients with long-term followed up were divided into unfavorable prognosis group and favorable prognosis group based on the prognosis of the patients （ by CPCs classification method ） .The general information , clinical in-formation （ including blood pressure and serum homocysteic acid level ） , GCS scores （ Glasgow coma scores）, and routine EEG and QEEG parameters and so on were compared between the groups , and ROC curve analysis was conducted on the predictive values of age , GCS score and QEEG parameter for the patients.Result：As for short-term prognosis, the GCS score （t=2.348, P=0.019） and SEF95%（t=3.446, P〈0.01） of the patients of the survival group were both higher than those of the death group , while the δ absolute energy （t=2.814, P〈0.01） and θ absolute energy （t=2.104, P=0.018） of the patients of the sur-vival group were both lower than those of the death group , and all the differences were statistically signifi-cant.As for long-term prognosis, the age （t=2.951, P〈0.01） and δabsolute energy （t=2.434, P〈0.01） of the patients of the favorable prognosis group were significantly lower than those of the unfavorable prognosis group, and GCS score （t=2.963, P〈0.01）, SEF95%（t=2.725, P〈0.01） and aEEG upper bound （t=2. 310, P〈0.01） of the patients of the favorable prognosis group were significantly higher than those of the unfavorable prognosis group .The combined predictive value of age , GCS score and QEEG data had an area under curve of 0.932, sensitivity of 91.80%and specificity of 91.02%, and was significantly better than the predictive value of single age , GCS score or QEEG data .Conclusion：QEEG parameters （ such as SEF95%, aEEG upper bound and δabsolute energy ） combined with the age and GCS score of patients with cerebral in-fraction have important predictive values for patients with widespread cerebral infarction in the MCA blood -supply area .