腦電圖反應性分級聯合腦干聽覺誘發電位對重型顱腦損傷患者的預后評估作用

劉稀金 張海艷 陳勇軍 張平 劉貴香 李欣

[摘要] 目的 探討腦電圖反應性分級聯合腦干誘發電位對重型顱腦損傷患者的預后評估作用。 方法 選取本院重癥監護病房的100例重型顱腦損傷昏迷患者，進行視頻腦電監測及腦干聽覺誘發電位監測，根據腦電圖反應性分級與患者預后進行分析，并進行預后準確率比較。 結果 患者腦電圖反應性分級與預后密切相關，分級越高，預后越差（χ2=61.575，P=0.043，P<0.05）;單獨應用視頻腦電圖對預后評價的敏感性和特異性偏低，通過視頻腦電圖反應性分級聯合腦干聽覺誘發電位，能顯著提高患者預后評估的準確性（χ2=6.814，P=0.039，P<0.05）。 結論 腦電圖反應性分級與腦干聽覺誘發電位相結合，在重型顱腦損傷患者預后評估中具有重要意義，值得在臨床推廣。

[關鍵詞] 重型顱腦損傷;腦電圖反應性分級;腦干聽覺誘發電位;昏迷;預后評估

[中圖分類號] R714? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 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，隨著我國老年化進程加快，自發性腦出血、工傷、車禍等疾病發病率日益上升，重型顱腦損傷患者數量較之前明顯增加。雖然目前醫學水平總體較之前提高，患者死亡率下降，但患者長期的昏迷狀態，給醫生的病情判斷造成困擾。因此，如何對昏迷患者預后進行有效評估，具有重要臨床及社會意義。本研究就腦電圖反應性分級聯合腦干誘發電位對重型顱腦損傷的預后評估作用進行探討，現報道如下。