床旁连续视频脑电图结合Synek脑电分级对重型颅脑损伤患者近期预后的评估价值

Analysis on value of long-term bedside continuous video electroencephalography combined with Synek electroencephalography grading in evaluating short-term prognosis of patients with severe traumatic brain injury

目的探讨床旁连续视频脑电图(CVEEG)结合Synek脑电分级对重型颅脑损伤患者近期预后的评估价值。方法采用回顾性研究方法。选择仙居县人民医院重症监护病房(ICU)2018年1月至2021年6月收治的148例重型颅脑损伤患者为研究对象。根据发病后2个月疾病转归将患者分为良好转归组、不良转归组和死亡组。患者均在入院时和入院7 d行CVEEG检查,并根据结果确定Synek脑电分级。比较不同预后3组患者入院时和入院7 d Synek脑电分级的差异;并采用Pearson或Spearman相关性分析法分析入院时和入院7 d Synek脑电分级与急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分、格拉斯哥昏迷评分(GCS)、格拉斯哥预后评分(GOS)的相关性。结果3组入院时Synek脑电分级患者比例比较差异均无统计学意义;入院7 d时,3组不同Synek脑电分级患者比例比较差异有统计学意义(χ^(2)=29.073,P<0.001),良好转归组Synek脑电分级患者比例以Ⅰ、Ⅱ级为主,分别占23.8%(10/42)、38.2%(16/42),而死亡组则以Ⅳ、Ⅴ级为主,分别占27.3%(6/22)、36.5%(8/22)。相关性分析显示,入院时Synek脑电分级与APACHEⅡ评分呈明显正相关(r=0.767,P<0.001);而入院时Synek脑电分级与GCS评分及入院7 d Synek脑电分级与GOS评分均呈明显负相关(r值分别为-0.562、-0.453,均P<0.001);而入院时Synek脑电分级与GOS评分及入院7 d Synek脑电分级与GCS评分和APACHEⅡ评分均无明显相关性(均P>0.05)。结论入院7 d时Synek脑电分级能准确预测重型颅脑损伤患者的近期预后,有助于指导临床决策,值得在临床上推广应用。

Objective To discuss the clinical prognostic value of long-term bedside continuous video electroencephalography(CVEEG)combined with Synek electroencephalography(EEG)grading in evaluating the shortterm prognosis of patients with severe traumatic brain injury.Methods A retrospective study was conducted.A total of 148 patients with severe traumatic brain injury admitted into the department of intensive care unit(ICU)of Xianju County People's Hospital from January 2018 to June 2021 were selected as the research subjects,according to the disease outcome 2 months after the onset of the disease,the patients were divided into three groups:good outcome group,bad outcome group and death group.All patients underwent bedside CVEEG at admission and 7 days after admission,and based on the examination results,the Synek EEG gradings were determined.The differences in Synek EEG gradings among the three groups at admission and 7 days after admission were compared;Pearson or Spearman correlation analysis was used to analyze the correlations of Synek EEG grades at admission and 7 days after admission with acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,Glasgow coma scale(GCS)and Glasgow outcome scale(GOS).Results There were no statistical significant differences in Synek EEG grading proportions among the three groups at admission;on 7 days after admission,there were statistical significant differences in the proportions of different Synek EEG gradings among the patients in the three groups(χ^(2)=29.073,P<0.001),in the good outcome group,the proportions of patients with Synek EEG grading were mainly in gradesⅠandⅡ,accounting for 23.8%(10/42)and 38.2%(16/42),respectively,whileⅣandⅤgrades were the main types in the death group,accounting for 27.3%(6/22)and 36.5%(8/22),respectively.Correlation analysis showed that the Synek EEG gradings at admission were significantly positively correlated with APACHEⅡscore(r=0.767,P<0.001);there were significant negative correlations between Synek EEG grading at admission and GCS score and Synek EEG grading 7 days after admission and GOS score(r values were-0.562,-0.453,respectively,both P<0.001).There were no significant correlations between Synek EEG grading at admission and GOS score and between Synek EEG grading on 7 days after admission and GCS score,APACHEⅡscore(all P>0.05).Conclusion On 7 days after admission,the Synek EEG grading can accurately predict the short-term prognosis of patients with severe traumatic brain injury,which can help guide clinical decision-making and it is worthy to popularize and apply in clinics.