脑干听觉诱发电位对重型颅脑损伤植物状态评估的价值

Evaluation of brain stem auditory evoked potentials for patients with severe traumatic brain injury in vegetative state

目的研究脑干听觉诱发电位 (BAEP)对重型颅脑损伤植物状态患者脑干功能的评估以及对预后判断的价值。方法对 30例重型颅脑损伤植物状态患者在综合康复治疗前及治疗 1个月后行BAEP检查及格拉斯哥昏迷量表 (GCS)评分。 6个月后进行随访 ,行格拉斯哥预后量表 (GOS)评分并复查BAEP。分析BAEP分级与GCS评分、GOS评分的关系以及清醒前后BAEP变化的特点。结果康复治疗前BAEP异常率为 93.3% ( 2 8/30例 ) ,康复治疗 1个月后BAEP异常率为 86 .7% ( 2 6 /30例 ) ,其中Ⅳ级减少 5例 ( 16 .7% ) ,而Ⅰ级增加 2例 ( 6 .7% )。BAEP分级越高 ,则预后越差。有 12例 ( 4 0 % )患者意识恢复 ,意识改善后BAEP的主要变化是Ⅴ波的出现 ,其次是各波分化的改善和潜伏期的缩短。结论BAEP检测可评估重型颅脑损伤植物状态患者脑干功能并为预后判断提供依据。Ⅴ波的出现提示脑干功能的恢复 。

ObjectiveTo study the value of brain stem auditory evoked potentials (BAEP) in evaluating the function of brainstem and judging the prognosis in patients with severe traumatic brain injury in vegetative state. Methods30 cases with severe traumatic brain injury in vegetative state were examined by BAEP and assessed with Glasgow Coma Scale (GCS) before comprehensive rehabilitation treatment and 1 month later. The patients were re-examined by BAEP and assessed with Glasgow Outcome Scale (GOS) after 6-month in follow-up. The relationship between BAEP grade and GCS or GOS was analyzed. The variety of BAEP in regaining consciousness was also analyzed.Results The abnormal rate of BAEP was 93.3% (28/30 cases) before rehabilitation treatment while it was 86.7% (26/30 cases) after 1 month. The higher the BAEP grade was, the poorer the prognosis was. There were 12 patients who regained consciousness.The main variety in these patients was the appearance of wave Ⅴ, as well as the improvement of each wave' shape and the shortening of peak latent period. ConclusionsBAEP can evaluate the function of brain stem in patients with severe traumatic brain injury in vegetative state and provide evidences for prognosis. The appearance of wave Ⅴ prompts the recovery of function of brain stem as an index of cerebral electrophysiology in improvement of consciousness.