量化脑电图与传统脑电图应用于重症颅脑损伤患者的对比研究

Quantitative electroencephalogram versus raw electroencephalogram in critical traumatic brain injury patients

目的探讨并比较量化脑电图(QEEG)与传统脑电图(REEG)探知重症颅脑损伤患者痫样放电的能力。方法 2015年12月至2016年8月,纳入中南大学湘雅医院综合ICU内重症颅脑损伤后意识障碍疑似出现痫样放电的患者18例,使用动态量化脑电监测进行6 h床旁监测,国际通用10~20系统安放8导联,同时留取传统脑电监测信号由2组医师分别独立解读,判断是否出现痫样放电并记录次数。整体量化脑电以及传统脑电信号交由2位专业脑电监测医师判读并作为金标准,统计两组数据的解读时间、痫样放电的捕捉次数从而计算并比较两种监测方式发现痫样放电的敏感性以及错误率。结果 QEEG与REEG探知痫样放电的敏感度存在显著差异[82.75%(50.00%~91.67%)vs 59.83%(0~83.33%),P=0.002],解读时间存在显著差异[3.28(5~9)min vs13.56(11~19)min,P<0.001],两种监测方式探知痫样放电的错误率无显著差异[0.09(0~0.67)次/h]vs 0.06(0~0.34)次/h,P=0.131]。结论综合ICU内使用QEEG较REEG监测重度颅脑损伤患者后痫样放电的敏感性更强,监测解读时间更短。

Objective To evaluate the sensitivity of quantitative electroencephalogram（QEEG） to detect electrographic seizure in critical traumatic brain injury patients in the intensive care unit（ICU） and further compare it to the raw electroencephalogram（REEG）. Methods Six-hour QEEG epochs with 8 electrodes with international 10-20 system were performed in 18 critical traumatic brain injury patients with suspect seizure. REEG was performed during the same time. Each epoch was reviewed by two groups of physician independently. Two neurophysiologists reviewed REEGs and QEEG to identify seizures to serve as the gold standard. Analysis time and seizure detected frequency of REEG and QEEG were compared to identify the sensitivity and error rate for seizure identification. Results A significant different sensitivity for seizure identification was found between QEEG and REEG [82.75%（50.00%-91.67%） vs 59.83%（0-83.33%）, P=0.002]. Analysis time was significant shorter in QEGG relative REEG [0.09（0-0.67） h vs 0.06（0-0.34） h, P 〈 0.001]. No significant false rate was found between two groups [0.09 per hour（0-0.67） vs 0.06 per hour（0-0.34）, P=0.131]. Conclusion QEEG can be used by doctors to shorten EEG review time with better sensitivity for seizure identification in critical traumatic brain injury patients with seizure in ICU.