动态视频脑电图监测在评估重症脑血管疾病患者预后中的应用

Dynamic video EEG monitoring in assessing the prognosis of patients with severe cerebrovascular disease

目的探讨针对重症脑血管患者,选择实施动态视频脑电图监测的预后作用。方法选取2018年9月至2020年2月江西省景德镇市第一人民医院急性重症脑血管患者60例,采用随机数字表法随机分为观察组与对照组,每组各30例,实施动态视频脑电图监测评估。观察组为(δ+θ)/(α+β)上升组,对照组为(δ+θ)/(α+β)下降组。比较分析比值变化情况预后及GCS与预后的关系等,比较不同时段动态视频脑电图的脑对称指数(BSI)及(δ+θ)/(α+β)转变,对患者预后做评价和相关预测。结果观察组死亡20例(66.67%),显著高于对照组的2例(6.67%);生存10例(33.33%),显著低于对照组的28例(93.33%)(P<0.05);相较于综合预后判断同患者死亡预测准确率,(δ+θ)/(α+β)比值变化均优于GCS,且GCS和(δ+θ)/(α+β)比值变化,与患者的预后呈现密切相关性(P<0.05);同干预前的社会、环境、躯体和心理各项评分相比,干预后患者的生活质量评分均明显较高(P<0.05);同干预前相比,实施动态视频脑电图监测后的GCS评分更高(P<0.05);与对照组的舒张压、收缩压、心率水平相比,观察组的各项指标均明显较低(P<0.05)。结论针对ICU发病24 h内急性重症脑血管患者,采用动态视频脑电图监测评估,可节约医疗资源和成本,对患者的疾病预后有预测性作用,具有临床应用价值。

Objective To investigate the role of dynamic video electroencephalogram(VEEG)monitoring in assessing the prognosis of patients with severe cerebrovascular disease(SCD).Methods A total of 60 patients with acute SCD in the department of neurology of Jingdezhen NO.1 People′s Hospital in Jiangxi Province from September 2018 to February 2020 were selected and randomly divided into the observation group and the control group with 30 cases in each group according to the random number table method.All patients were subject to the assessment by dynamic VEEG monitoring.The observation group was taken as the group with increasing(δ+θ)/(α+β)ratio and the control group with decreasing(δ+θ)/(α+β)ratio.The correlation between the prognosis and ratio changes,and between the prognosis and Glasgow Coma Scale(GCS)scores were comparatively analyzed,and the changes in Brain Symmetry Index(BSI)and(δ+θ)/(α+β)ratio of dynamic VEEG in different periods were compared between the two groups,so as to assess and predict the prognosis of patients with SCD.Results The number of deaths in the observation group(20 cases[66.67%])was significantly higher than that in the control group(2 cases[6.67%]),and the number of survivals in the observation group(10 cases[33.33%])was significantly lower than that in the control group(28 cases[93.33%])(P<0.05).The changes of(δ+θ)/(α+β)ratio had higher accuracy in assessing prognosis and predicting death than GCS,and both GCS and changes of(δ+θ)/(α+β)ratio were closely correlated with the prognosis of patients(P<0.05).The scores in social,environmental,somatic and psychological dimensions of the quality of life scores were significantly higher after the intervention than those before the intervention(P<0.05).The GCS scores were higher after the implementation of dynamic VEEG monitoring than those before the intervention(P<0.05).The levels of diastolic blood pressure,systolic blood pressure and heart rate in the observation group were significantly lower than those in the control group(P<0.05).Conclusion For patients with acute SCD within 24 h of onset in the ICU of the department of neurology,the application of dynamic VEEG monitoring and assessment can save medical resources and costs,and is of value in predicting the disease prognosis.Therefore,it is worthy of clinical application.