腦電圖反應(yīng)性分級(jí)聯(lián)合腦干聽(tīng)覺(jué)誘發(fā)電位對(duì)重型顱腦損傷患者的預(yù)后評(píng)估作用

劉稀金 張海艷 陳勇軍 張平 劉貴香 李欣

[摘要] 目的 探討腦電圖反應(yīng)性分級(jí)聯(lián)合腦干誘發(fā)電位對(duì)重型顱腦損傷患者的預(yù)后評(píng)估作用。 方法 選取本院重癥監(jiān)護(hù)病房的100例重型顱腦損傷昏迷患者，進(jìn)行視頻腦電監(jiān)測(cè)及腦干聽(tīng)覺(jué)誘發(fā)電位監(jiān)測(cè)，根據(jù)腦電圖反應(yīng)性分級(jí)與患者預(yù)后進(jìn)行分析，并進(jìn)行預(yù)后準(zhǔn)確率比較。 結(jié)果 患者腦電圖反應(yīng)性分級(jí)與預(yù)后密切相關(guān)，分級(jí)越高，預(yù)后越差（χ2=61.575，P=0.043，P<0.05）;單獨(dú)應(yīng)用視頻腦電圖對(duì)預(yù)后評(píng)價(jià)的敏感性和特異性偏低，通過(guò)視頻腦電圖反應(yīng)性分級(jí)聯(lián)合腦干聽(tīng)覺(jué)誘發(fā)電位，能顯著提高患者預(yù)后評(píng)估的準(zhǔn)確性（χ2=6.814，P=0.039，P<0.05）。 結(jié)論 腦電圖反應(yīng)性分級(jí)與腦干聽(tīng)覺(jué)誘發(fā)電位相結(jié)合，在重型顱腦損傷患者預(yù)后評(píng)估中具有重要意義，值得在臨床推廣。

[關(guān)鍵詞] 重型顱腦損傷;腦電圖反應(yīng)性分級(jí);腦干聽(tīng)覺(jué)誘發(fā)電位;昏迷;預(yù)后評(píng)估

[中圖分類號(hào)] R714? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] B? ? ? ? ? [文章編號(hào)] 1673-9701（2021）24-0038-03

EEG reactivity grading combined with brainstem auditory evoked potentials on prognostic assessment of patients with severe craniocerebral injury

LIU Xijin? ?ZHANG Haiyan? ?CHEN Yongjun? ?ZHANG Ping? ?LIU Guixiang? ?LI Xin

Department of Neurology，Nanhua Hospital Affiliated to University of South China，Hengyang? ?421000，China

[Abstract] Objective To investigate the prognostic assessment effect of electroencephalogram （EEG） reactivity grading combined with brainstem evoked potentials in patients with severe craniocerebral injury. Methods A total of 100 patients with severe craniocerebral injury hospitalized in the intensive care unit of our hospital from September 2017 to May 2020 were selected.Video EEG monitoring followed by brainstem auditory evoked potential monitoring was performed on each patient. The prognosis was analyzed according to the EEG reactivity grade and the prognosis， and the prognosis accuracy was compared. Results The patient′s EEG reactivity grading was closely related to the prognosis，the higher the grade，the worse the prognosis （χ2=61.575，P=0.043，P<0.05）.EEG monitoring alone had low sensitivity and specificity for patients′ prognostic assessment，and the combination of EEG reactivity grading and brainstem auditory evoked potential monitoring significantly improved the accuracy of prognostic assessment（χ2=6.814，P=0.039，P<0.05）. Conclusion The combination of EEG reactivity grading and brainstem auditory evoked potentials has excellent significance for the prognostic assessment of patients with craniocerebral injury，which is worthy of promotion in clinical practice.

[Key words] Severe craniocerebral injury; Electroencephalogram reactivity grading; Brainstem auditory evoked potentials; Coma; Prognostic assessment

重型顱腦損傷（Severe brain injury，SBI）患者是臨床上的危重癥，隨著我國(guó)老年化進(jìn)程加快，自發(fā)性腦出血、工傷、車禍等疾病發(fā)病率日益上升，重型顱腦損傷患者數(shù)量較之前明顯增加。雖然目前醫(yī)學(xué)水平總體較之前提高，患者死亡率下降，但患者長(zhǎng)期的昏迷狀態(tài)，給醫(yī)生的病情判斷造成困擾。因此，如何對(duì)昏迷患者預(yù)后進(jìn)行有效評(píng)估，具有重要臨床及社會(huì)意義。本研究就腦電圖反應(yīng)性分級(jí)聯(lián)合腦干誘發(fā)電位對(duì)重型顱腦損傷的預(yù)后評(píng)估作用進(jìn)行探討，現(xiàn)報(bào)道如下。