振幅整合脑电图在意识障碍患儿中的临床应用

Clinical application of amplitude-integrated electroencephalogram in children with disturbance of consciousness

目的探讨振幅整合脑电图(aEEG)评估意识障碍患儿脑功能预后的临床价值。方法选择2018年10月至2019年9月郑州大学第三附属医院儿科重症监护病房(PICU)收治的意识障碍患儿100例为研究对象,于入院48 h内完成aEEG及视频脑电图(vEEG)(监测≥6 h)、改良格拉斯哥昏迷评分(GCS)、外周血脑损伤标志物S100β蛋白及神经元特异性烯醇化酶(NSE)检测,并记录上述判读结果。以发病6个月或临床死亡为研究终点,依据儿童脑功能评分(PCPC)采用电话随访形式追踪患儿实际预后。采用受试者工作特征曲线(ROC)对aEEG、vEEG、改良GCS评分、S100β蛋白和NSE评估意识障碍患儿脑功能预后的临床效能进行分析和比较,应用Kappa一致性检验评估预后与实际预后的相关性。结果构建aEEG与vEEG、改良GCS、S100β蛋白、NSE脑功能评估方法ROC,得出曲线下面积依次为0.847、0.810、0.729、0.685、0.784,用于评估脑功能预后均有统计学意义(均P<0.05)。以Z评分法为金标准,aEEG与S100β蛋白评估脑功能预后的临床效能具有显著性差异(Z>1.96,P<0.05),与其余3种相比差异无统计学意义。以最佳截断值为评估预后标准,aEEG评估预后不良的敏感性最高(90.5%),经Kappa一致性检验,aEEG评估预后与实际预后具有一致性(Kappa=0.550,P<0.01)。结论aEEG对意识障碍患儿脑功能预后具有较好的评估价值,敏感性高,与临床实际预后具有一致性,可在PICU诊治工作中推广应用。

Objective To investigate the clinical application value of amplitude-integrated electroencephalogram (aEEG) in evaluating the prognosis of brain function in children with disturbance of consciousness.Methods A total of 100 children with disturbance of consciousness admitted to the pediatric intensive care unit (PICU) in the Third Affiliated Hospital of Zhengzhou University from October 2018 to September 2019 were enrolled.All patients completed aEEG and video electroencephalogram (vEEG) (monitoring hours≥ 6 h), modified Glasgow coma scale (GCS) rating, peripheral blood brain injury marker S100β protein and neuron-specific enolase (NSE) detection within 48 hours of admission.The prognosis was evaluated based on the above results.The actual prognosis of the children was recorded by telephone follow-up based on the pediatric cerebral performance category score (PCPC) until 6 months of onset or clinical death.The receiver operating characteristic curve (ROC) was used to analyze and compare the clinical efficacy of aEEG, vEEG, improved GCS, S100β protein, and NSE in evaluating the prognosis of brain function in children with disturbance of consciousness.Kappa consistency test was made to evaluate the correlation between the estimated prognosis and the actual prognosis.Results The area under the ROC curve (AUC) of aEEG, vEEG, improved GCS, S100β protein and NSE was 0.847, 0.810, 0.729, 0.685 and 0.784, respectively, indicating the five methods had statistically significant value in evaluating the prognosis of brain function (all P<0.05). Taking the Z value as the gold standard, the clinical efficacy of aEEG in evaluating the prognosis of brain function was significantly different from that of S100β (Z>1.96, P<0.05), but showed no significant difference with that of other 3 methods.Using the best cut-off value as the gold standard for evaluating the prognosis, aEEG had the highest sensitivity to evaluate a poor prognosis (90.5%). The Kappa consistency test showed that the prognosis predicted by aEEG was consistent with the actual prognosis (Kappa=0.550, P<0.01).Conclusionsa EEG has a good evaluation value for the brain function prognosis of children with disturbance of consciousness.aEEG has high sensitivity, and the predicated prognosis is consistent with the actual clinical prognosis, so it can be widely used in the diagnosis and treatment of PICU.