脑电监测α变异百分率与重型急性脑梗死发病90天预后的相关性研究

Study on correlation between percent alpha variability and clinical prognosis in patients with severe actue cerebral infarction

目的通过持续监测重型急性脑梗死患者皮层脑电定量参数α变异百分率的动态变化,评价其在重型急性脑梗死发病90天的临床预后预测方面的临床应用价值。方法入选重型急性脑梗死患者31例,常规行定量连续脑电监护及临床诊治。记录患者入院24 h、48 h、72 h的平均α变异百分率,并对入组病人入院时及发病90天进行NIHSS评分、GCS评分、CNFD评分;根据预后情况分为预后良好与预后不良组;分析两组间α变异百分率的差异及与重型急性脑梗死90天临床预后的相关性。结果 (1)α变异百分率与受累的大脑半球相关,病变侧大脑半球的α变异百分率较非病变侧大脑半球α变异百分率低;入院后72 h内,随着发病时间的延长,α变异百分率呈逐渐减少的趋势。(2)预后良好组入院0~24 h(t=2.741,P=0.013)、24~48 h(t=2.345,P=0.035)、48~72 h(t=3.386,P=0.001)的平均α变异百分率(病变侧)均值较预后不良组明显增高;Spearman分析中提示,发病早期的病变侧α变异百分率(0~24 h、24~48 h,48~72 h)与良好预后呈正相关,分别为r=0.387,P<0.001;r=0.489,P<0.001;r=0.418,P<0.001。(3)入院0~24 h、24~48 h、48~72 h病变侧α变异百分率均对良好预后具有辨别预测能力,ROC曲线分析当α变异百分率≥20%时预测良好预后的灵敏度分别为68.4%、63.2%、63.2%、特异性分别为66.7%、75.0%、91.7%。结论α变异百分率与重型急性脑梗死90天良好预后呈正相关。临床上有望通过连续脑电监测α变异百分率这一定量化脑电参数,以预测重型急性脑梗死发病90天的病情转归。

Objective To analyze the correlation between percent alpha variability and clinical prognosis in patients with severe actue cerebral infarction after 90 days,and evaluate its clinical practical value of the clinical prognosis. Methods Thirty-one patients with severe actue cerebral infarction were accepted continuous brain function monitoring and clinical diagnosis and treatment. All patients in group were accepted the continuous 72 hours of continuous brain function monitor,and were recorded the average of Percent Alpha Variability which admitted to hospital 24 h,48 h,72 h. And scored the NIHSS,GCS,CNFD when admitted to hospital,and 90 days after onset. According to the clinical prognosis,the patients were divided into good and poor prognosis groups,and the correlation between Percent Alpha Variability and clinical prognosis were analyzed in patients with severe actue cerebral infarction after 90 Days. Results The Percent Alpha Variability was associated with the affected hemisphere. The Percent Alpha Variability of affected hemisphere is lower than the no-affected hemisphere.Between good prognosis and poor prognosis groups,there were significant differences of the score of the percent alpha variability in the hospital within 0-24 h,24-48 h,48-72 h. Spearman analysis indicatedthe percent alpha variability in the hospital within 0-24 h,24-48 h,48-72 h were positive correlated with good prognosis. The percent alpha variability in the hospital within 0-24 h,24-48 h,48-72 h predicted good prognosis. The sensitivity and specificity of good prognosis would be high when the percent alpha variability≥20%. The sensitivity of the percent alpha variability in the hospital within 0-24 h,24-48 h,48~72 h was 68.4%,63.25,63.2%,and the specificity was 66.7%,75.0%,91.7%. Conclusion The percent alpha variability of affected hemisphere in the hospital within 72 h was positively correlated with good prognosis in severe acute cerebral infarction. To some extent,the percent alpha variability could predict the clinical prognosis of severe acute cerebral infarction.