床旁脑电图早期预测恶性大脑中动脉供血区梗死  

Early prediction of malignant middle cerebral artery infarction with bedside electroencephalography

作　　者：赵经纬[1] 宿英英[1] 李霞[1] 王琳[1] 刘甜甜[1] 

机构地区：[1]首都医科大学宣武医院神经内科ICU,北京100053

出　　处：《国际脑血管病杂志》2010年第2期81-86,共6页International Journal of Cerebrovascular Diseases

基　　金：首都医学发展科研基金（2007-1043）

摘　　要：目的探讨床旁脑电图（electroencephalography,EEG）早期预测恶性大脑中动脉供血区梗死（malignant MCA infarction,mMCAI）的可能性和准确性。方法对35例发病48h内大脑半球大面积脑梗死（massive hemispheric infarction,MHI）患者行床旁EEG检测，盲法判读EEG指标，并分析临床、实验室和影像学指标；按发病7d内是否发生mMCAI，分为mMCAI组和非mMCAI组，比较两组患者EEG指标以及临床、实验室和影像学指标之间的差异，分析差异显著并具有统计学意义的指标出现时，发生mMCAI的优势比（oddsratio，OR）并计算其预测mMCAI的准确性。结果35例Mm患者中mMCAI组20例，非mMCAI组15例，两组间EEG指标[梗死对侧枕部Or．节律解体、梗死对侧广泛性慢波、梗死对侧优势频率波低波幅、区域性无8波减弱（regional attenuation without delta,RAWOD）模式、EEG反应性消失]、临床指标（恶心伴呕吐）和影像学指标（梗死范围超过整个MCA供血区、透明隔层面中线结构向对侧移位3～5mm）均具有显著差异（P〈0．05），其中出现梗死对侧枕部α节律解体的患者发生mMCAI的风险最高（OR=22．67，95％CI3．89～132．10），预测mMCAI的敏感性为85．0％，特异性为80．0％，阳性预测值为85．0％，阴性预测值为80．0％，优于其他EEG指标以及临床和影像学指标。结论床旁EEG指标能早期预测mMCAI，而且预测准确性优于临床和影像学指标。Objective To investigate the possibility and accuracy of predicting malignant middle cerebral artery infarction （mMCAI） with bedside electroencephalography （EEG）. Methods ]hirty-five patients with massive hemispheric infarction （MHI） underwent bedside EEG monitoring within 48 h of onset. The EEG indicators were interpreted blindly, and the clinical, laboratory and imaging parameters were analyzed. The patients were divided into mMCAI group and non-mMCAI group according to whether they had occurred mMCAI or not within 7 days of onset. The differences of EEG indicators, clinical, laboratory and imaging parameters between the 2 groups were compared. When the parameters of significant difference and statistical significance appeared the odds ratio （OR） of occurring mMCAI were analyzed, and their accuracy of predicting mMCAI was calculated. Results Of the 35 patients with MHI, 20 were in the mMCAI group and 15 were in the non-mMCAI group. There were significant differences in the EEG indicators （infarction on the contralateral side, including disintegration of occipital α rhythm, generalized slow-wave, dominant frequency wave low amplitude, regional attenuation without delta [ RAWOD] pattern, and absence of EEG reactivity）, clinical parameters （nausea accompanied with vomiting）, and imaging parameters （the infracted area more than the entire MCA territory, and midline shifting 3 to 5 mm at the level of septum pellucidum） between the 2 groups （P 〈0.05）. Of those, the risk of mMCAI was the highest in patients with disintegration of occipital α rhythm on the contralateral side of infarction （P = 22. 67, 95% CI3. 89-132. 10）. The sensitivity of predicting mMCAI was 85.0%, the specificity was 80.0%, the positive predictive value was 85.0%, and the negative predictive value was 80.0%, which were superior to other EEG indicators and clinical or imaging parameters. Conclusions Bedside EEG indicators can early predict mMCAI, moreover, the predictive accuracy is superior to the clinical a

关 键 词：脑电描记术 脑梗死 监测 生理学 

分 类 号：R743.3[医药卫生—神经病学与精神病学]