BSR与BAEP对颅脑损伤后长期意识障碍患者清醒的预测作用

The prediction of awakening by brainstem reflex and BAEP in patients with long-term conscious disturbance after traumatic brain injury

目的探讨脑干反射(BSR)与脑干听觉诱发电位(BAEP)检查对颅脑损伤后长期意识障碍患者清醒的预测效果。方法2013年8月至2015年9月收治颅脑损伤后长期意识障碍患者75例,均接受BSR及BAEP检查。伤后6个月内清醒42例(清醒组),未清醒33例(未清醒组;包括死亡、植物生存状态)。结果清醒组BSR分级Ⅰ级18例,Ⅱ级16例,Ⅲ级8例;未清醒组BSR分级Ⅰ级4例,Ⅱ级2例,Ⅲ级14例,Ⅳ级13例;两组BSR分级差异有统计学意义(P<0.05)。将BSR分级Ⅰ级、Ⅱ级作为患者容易清醒的指标,将Ⅲ级、Ⅳ级作为患者难于清醒的指标,其特异度、灵敏度分别为87.50%、81.03%。清醒组BAEP分级Ⅰ级27例,Ⅱ级15例;未清醒组Ⅰ级7例,Ⅱ级17例,Ⅲ级9例;两组BAEP分级差异有统计学意义(P<0.05)。将BAEP分级Ⅰ级作为患者容易清醒的指标,将Ⅲ级作为患者难于清醒的指标,其特异度、灵敏度分别为95.67%、78.13%。结论对颅脑损伤后长期意识障碍患者采用BSR及BAEP检查,可有效对患者清醒情况进行预测,为临床防治颅脑损伤提供依据。

Objective To investigate the effects of brainstem reflex （BSR） and brainstem auditory evoked potential （BAEP） on prediction of awakening in the patients with long-term conscious disturbance （LTCD） after traumatic brain injury （TBI）. Methods Seventy-five patients with LTCD after TBI who treated in our hospital from August, 2013 to September, 2015 served as the objects of study, and all the patients received BSR examination 1, 7, 15, 30, 60 and 120 days after admission to hospital and BAEP examination 7 days after admission to hospital. All the patients were divided into conscious group and unconscious group （including died and persistent vegetative state patients） according to consciousness status six months after the injury. The correlation of BSR and BAEP with patients＇ consciousness was analyzed. Results The grades of BSR and BAEP were negatively related to the conscious rate of patients with LTCD after TBI （r=-0.574, -0.667, P=0.008, 0.005）. The grade Ⅰ and grade Ⅱ of BSR served as the indicators that patients were likely to awake, and grade Ⅲ, grade Ⅳ as the indicators that patients were unlikely to awake, and their specificity and sensitivity were 87.50% and 81.03% respectively. The grade Ⅰ of BAEP served as the indicators that patients were likely to awake, and grade Ⅲ as the indicators that patients were unlikely to awake and their specificity and sensitivity were 95.67% and 78.13% respectively. Conclusion BSR and BAEP examinations were very helpful to predicting the awakening in patients with LTCD after TBI and provide the basis for clinical treatment of TBI.