急性脑梗死早期神经功能恶化患者的脑电图变化及其临床意义

Changes of electroencephalogram in the diagnosis of early neurological deterioration in patients with acute cerebral infarction and its clinical significance

目的:观察急性脑梗死早期神经功能恶化患者的脑电图变化及其临床意义。方法:回顾性分析2017年1月至2018年2月在商丘市第一人民医院完成治疗的86例急性脑梗死患者的临床资料,纳入患者均接受脑电图检查,并采用美国国立卫生研究院卒中量表(NIHSS)评估患者发病72 h时的早期神经功能恶化情况,依据NIHSS评分将患者分为恶化组(15例)与无恶化组(71例),比较两组的脑电图变化,分析脑电图变化与早期神经功能恶化的关系。结果:急性脑梗死患者的α、β、δ、θ、DTABR值分别为(18.78±5.24)Hz、(9.03±5.12)Hz、(43.23±10.47)Hz、(29.36±9.16)Hz、1.17±0.39。86例患者中15例出现神经功能恶化,恶化发生率为17.44%。恶化组δ、θ及DTABR值均高于无恶化组,α、β值均低于无恶化组,差异有统计学意义(P<0.05);相关性检验结果显示,脑电图中α、β值与早期神经功能恶化情况(NIHSS增加分值)均呈负相关(r<0,P<0.05);δ、θ及DTABR值与早期神经功能恶化均呈正相关(r>0,P<0.05);绘制受试者工作特征曲线得到各检验变量(α、β、δ、θ、DTABR值)预测急性脑梗死患者早期神经功能恶化的曲线下面积分别为0.935、0.972、0.917、0.895、0.918,均>0.85,有一定预测价值。结论:急性脑梗死患者早期脑电图异常改变可能预示着早期神经功能恶化高风险,临床可依据脑电图变化判断患者的神经功能情况,尽早给予合理干预。

Objective To observe the changes of electroencephalogram(EEG)in the diagnosis of early neurological deterioration in patients with acute cerebral infarction,and its significance.Methods The clinical data from 86 patients with acute cerebral infarction who were treated in the First People’s Hospital of Shangqiu from January 2017 to February 2018 were retrospectively analyzed.All patients underwent EEG examination.The National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the degree of neurological deterioration 72 hours after onset of the disease.According to the NIHSS scores,patients were divided into deterioration group(15 cases)and non-deterioration group(71 cases).The EEG changes of the two groups were compared.And the relationship of EEG changes with neurological deterioration was analyzed.Results The values ofα,β,δ,θ,and Deltaratio,Symmecry thetalalpha+beta rate(DTABR)of patients with acute cerebral infarction were(18.78±5.24)Hz,(9.03±5.12)Hz,(43.23±10.47)Hz,(29.36±9.16)Hz and 1.17±0.39,respectively;15 of 86 patients had neurological deterioration,and the incidence of deterioration was 17.44%.The values of theδ,θ,and DTABR of the deterioration group were higher than those of the non-deterioration group,while the values ofαandΒwere lower than those of the non-deterioration group,and the difference was statistically significant(P<0.05).Correlation test results showed that theαandβvalues of EEG were negatively correlated to degree of early neurological deterioration(NIHSS average increase score),r<0,P<0.05.The values ofδ,θand DTABR were positively correlated to early neurological deterioration(r>0,P<0.05).The area under the receiver operating characteristic curve of each test variable(α,Β,δ,θ,DTABR values)in predicting early neurological deterioration in patients with acute cerebral infarction were 0.935,0.972,0.917,0.895,0.918,respectively,all of them>0.85,suggesting that these indexes had certain predictive value.Conclusions Abnormal changes in early EEG of patients with acute cerebral infarction may indicate a high risk of early neurological deterioration.In clinical,the neurological foundation of patients with acute cerebral infarction can be judged on the basis of changes in EEG,and reasonable intervention can be given as soon as possible.