无创脑电磁扰动在蛛网膜下腔出血术后脱水治疗中的应用研究  

Application study of non-invasive brain electromagnetic disturbance in the treatment of dehydration after subarachnoid hemorrhage

作　　者：潘鹏宇 孔睿 李侑埕 李佳朔 杨新宇 张文旭 朱泽超 田学实 闻亮 朱廷准 梁国标 Pan Pengyu;Kong Rui;Li Youcheng;Li Jiashuo;YangXinyu;Zhang Wenxu;Zhu Zechao;Tian Xueshi;Wen Liang;Zhu Tingzhun;Liang Guobiao(Department of Neurosurgery,General Hospital Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院神经外科,沈阳110016

出　　处：《中华神经创伤外科电子杂志》2022年第6期351-355,共5页Chinese Journal Of Neurotraumatic Surgery：Electronic Edition

基　　金：辽宁省"兴辽人才计划"(XLYC2002109);辽宁省重点研发计划(2019JH8/10300085);沈阳市科技计划(20-205-4-017)

摘　　要：目的研究无创脑电磁扰动在蛛网膜下腔出血(SAH)后脑水肿程度的检测作用以及对脱水药物使用的指导作用。方法选取北部战区总医院神经外科自2019年6月至2020年6月行手术治疗的SAH患者56例。患者术后每日在甘露醇使用前和使用后2 h进行电磁扰动检测,记录DC值,比较术后1~7 d甘露醇使用前后DC值差异,采用受试者工作特征(ROC)曲线评估术后第5天的DC值对过早减量/停药的预测效力。结果术后1~7 d,每日使用甘露醇之前DC值随时间增加逐渐减少,且使用甘露醇后2 h的DC值均小于使用甘露醇之前,差异有统计学意义(P<0.05)。Spearman分析结果显示,DC值与时间成负相关关系(r=-0.720,P<0.001)。术后1~7 d的甘露醇使用前后DC值差值比较,差异均无统计学意义(F=0.948,P=0.422)。每日甘露醇使用之前DC值均与颅内压成正相关(P<0.05)。术后第5天DC值判断过早的甘露醇减量/停药,曲线下面积为0.79(95%CI:0.59~0.99),最佳DC值截断点为131,敏感度为87.5%,特异度为50%。结论无创电磁扰动技术可以观察SAH后脑水肿以及脱水治疗的变化过程,并且可以为脱水治疗提供依据。DC值可能成为SAH后脱水治疗效果的评价方式,为患者带来益处。ObjectiveTo study the effect of non-invasive brain electromagnetic disturbance in detecting the degree of cerebral edema after subarachnoid hemorrhage(SAH)and the guidance on the use of dehydrating drugs.MethodsA total of 56 patients with SAH underwent surgical treatment in Neurosurgery Department of the General Hospital Northern Theater Command from June 2019 to June 2020 were analyzed.The electromagnetic disturbance detection was performed every day before and 2 h after mannitol administration,and the DC value was recorded.The difference in the DC value was compared before and after the mannitol administration 1-7 d after the operation.The predictive efficacy of the DC value on the premature mannitol reduction/withdraw on the fifth day after the operation was assessed by receiver operating characteristic(ROC)curve.ResultsFrom 1 to 7 days after operation,the DC value decreased gradually with the increase of time before the application of mannitol,and the DC value 2 h after mannitol administration was lower than that before mannitol administration,and the difference was statistically significant(P<0.05).Spearman analysis showed that the DC value was negatively correlated with time(r=-0.720,P<0.001).There was no statistically significant difference in DC values before and after mannitol administration 1-7 d after surgery(F=0.948,P=0.422).DC value was positively correlated with intracranial pressure before daily mannitol administration(P<0.05).Premature mannitol reduction/withdraw was determined by DC value on day 5 after operation,the area under the curve was 0.79(95%CI:0.59-0.99),the optimal cut-off point of the DC value was 131,the sensitivity was 87.5%,and the specificity was 50%.ConclusionNon-invasive electromagnetic perturbation technique can observe the changes of cerebral edema after SAH and the treatment of dehydration,and can provide evidence for the treatment of dehydration.DC value may be an evaluation method to evaluate the therapeutic effect of dehydration after SAH and bring benefits to patients.

关 键 词：无创电磁扰动 扰动系数 蛛网膜下腔出血 颅内动脉瘤 脱水 

分 类 号：R74[医药卫生—神经病学与精神病学]